Multidisciplinary perioperative pathway decreased length of stay for lumbar fusion
Researchers found an overall cost reduction of $849,000 due to decreased length of stay.
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Results of a study presented at the American Association of Neurological Surgeons Annual Meeting showed a significant decrease in length of stay and total costs for patients undergoing single level lumbar fusion with implementation of a multidisciplinary perioperative pathway.
“We were looking to find an optimal average length of stay that patients should be in the hospital [for lumbar fusion],” George Timothy Reiter, MD, FAANS, lead author of the study, told Orthopedics Today. “We were not looking to make it zero [days]. We were seeing if we could have it the least number of days that is appropriate for them.”
To optimize length of stay for single level spine fusion patients, Reiter and his colleagues from Penn State Health Milton S. Hershey Medical Center used data collected from the Time-Driven Activity-Based Costing to develop a multidisciplinary perioperative pathway that involved changes in the consent process, review of the usual hospital course and setting patient expectations in the preoperative visit.
“We felt that by setting the expectations of the patient for what we thought was a good length of stay that we thought we were able to accomplish getting to that goal,” Reiter said about the study, which received the Robert Florin Award.
Length of stay was the primary outcome and cost changes was the secondary outcome studied. Researchers compared patient populations before and after implementation of the protocol.
Results showed a significant decrease in average length of stay from 4.1 days to 3.2 days after implementation of the protocol. Researchers found an average cost savings of $1,271 per case after implementation with a total reduced cost of $121,000 attributable to the length of stay.
The new contribution margin from additional capacity was $728,000, according to the results. This resulted in an overall cost reduction to $849,000.
Reiter and his colleagues are now tying this length of stay data in with patient-reported outcomes to identify any differences before and after the protocol was implemented.
“We are looking at trying to … extend [the perioperative pathway] out to more of a preoperative part and postoperative part, just scripting the whole care when the patient comes in to when the patient leaves,” Reiter said. – by Casey Tingle
Reference:
Zammar S, et al. Abstract 405. Presented at: American Association of Neurological Surgeons Annual Meeting; April 13-17, 2019; San Diego.
For more information:
George Timothy Reiter, MD, FAANS, can be reached at 30 Hope Dr., Suite 1200, Building B, Hershey, PA 17033; email: greiter@pennstatehealth.psu.edu.
Disclosure: Reiter reports no relevant financial disclosures.