In today’s ambulatory surgery centers, more complex surgical procedures are being safely performed while providing a clear economic benefit in an era of cost containment. The development of improved anesthetics and minimally invasive surgical techniques have made the growth of ambulatory surgery possible. These advances have helped to decrease hospital resource utilization, morbidity and mortality, and procedural costs and improve patient satisfaction and OR efficiency.
With decreasing revenues and increasing cost of resources, there has been more focus on improving ambulatory surgery efficiency and resource management without jeopardizing patient safety and quality of care. Because operating room turnover rates and length of recovery can have a significant impact on costs for ambulatory centers, the Anesthesiologist has an important part in helping to reduce costs in the ambulatory surgery setting. Cost reduction and increased productivity is directly related to efficiency. There is a 25%-75% reduction in overall cost for most operations performed in an outpatient versus inpatient setting. Preoperative, operating room, and postoperative phases of care should be streamlined to improve productivity.
In the preoperative setting, timely preoperative evaluation and screening should minimize cancellations and delays. The recognition and optimization of medical conditions preoperatively is very important. When compared to hospitalized patients, fewer preoperative lab tests and unnecessary screening tests are done further reducing costs.
The operating room is a major source of perioperative costs. Efficiency is decreased by cancellation rate, underutilization, rooms running late, intraoperative complications, and overall costs. Anesthesiologists can impact the efficiency of the OR by choosing anesthetic options that are cost-effective, safe, have minimal side-effects, and facilitate a rapid recovery. General anesthesia remains the most widely used anesthetic technique in ambulatory surgery. This has a higher incidence of side effects than local or regional anesthesia. The appropriate use of prophylactic drugs and ancillary equipment such as airway humidifiers, minimally invasive airway devices, and forced air warmers can improve recovery time help to reduce costs. MAC techniques provide low-cost, faster recovery, and higher patient satisfaction; however, not all surgical procedures are amenable to this technique.
Delays in PACU discharge or unanticipated hospital admission significantly increase the cost of ambulatory surgery. PONV and pain are the most common contributors to delay in PACU discharge. The “fast-track” process may decrease cost by reducing the amount of time spent in the postoperative period. This is especially important when the peak number of patients in the PACU is high. This process, in conjunction with anesthetic techniques that include antiemetic and analgesic prophylaxis, are important for reducing postoperative stay.
As the number of available hospital beds declines, ambulatory surgery with play an even more important part in reducing overall healthcare costs. A focus on streamlining the patient through the ambulatory surgery process, while maintaining quality and safety, is vital in reducing costs. The Anesthesiologist can contribute by choosing anesthetic techniques that minimize side-effects, decrease anesthesia time, and provide rapid recovery.
Girish P Joshi Efficiency in ambulatory surgery center. Curr Opin Anaesthesiol: 2008, 21(6);695-8