MP46-09 THE IMPLEMENTATION OF A PERIOPERATIVE SURGICAL HOME IS ASSOCIATED WITH DECREASED POSTOPERATIVE LENGTH OF STAY AND COST: A PILOT STUDY

INTRODUCTION AND OBJECTIVES: The current political and economic climate with regards to healthcare policy has incentivized hospitals to explore new ways to deliver high quality, costeffective care. This study describes the implementation of a multidisciplinary “perioperative surgical home” (PSH) aimed at streamlining care and reducing costs. Urologists partnered with anesthesiologists to lead a team to decrease unnecessary perioperative testing as well as make postoperative care more timely and less fragmented. METHODS: Retrospective chart review was performed on patients at a single institution undergoing radical prostatectomy (RP), radical cystectomy (RC), partial nephrectomy (PN), and radical nephrectomy (RN) from 1/2014 to 9/2015. Patients were divided into 2 groups; before implementation of a PSH (1/1/2014 - 12/31/2014, n=118) and after (1/1/2015 - 9/30/2015, n=123). Outcomes measured were length of stay (LOS), number of requested consults, readmissions, and complications. Statistical analysis was performed using Independent Samples Mann-Whitney U test (LOS and number of consults) and Fisher's Exact Test (readmission and complication rate) with a p value < 0.05 considered statistically significant. RESULTS: Average LOS was 3.43 days in the PSH group, vs 4.78 in the pre-PSH group, which was statistically significant (p < 0.001). Number of requested consults, readmission rate, and complication rate were not statistically different between the 2 groups. Subset analysis was performed by surgery type. Average LOS was significant for the RC group (9.00 vs 10.41, p = 0.004; n=19 in PSH, n=22 in pre-PSH). There was a trend to decreased LOS in the RN (3.23 vs 4.04, p = 0.169; n=31 in PSH, n=45 in pre-PSH) and PN group (3.00 vs 4.45, p = 0.116; n= 15 in PSH, n=20 in pre-PSH), but this was not significant. Average direct cost of urologic oncology patients was calculated as $4,059/day. With an average LOS difference of 1.35 for 123 patients, this translates to a $673,996 decrease in direct costs. CONCLUSIONS: The adoption of a PSH has led to a significantly decreased postoperative hospital stay for urologic surgery patients with no change in postoperative complication or readmission rates, thus decreasing direct costs to the hospital. This model appears best suited for a situation where there is a fixed re-imbursement for a surgical event and its sequela. By redefining practice roles, quality can be maintained at a lower cost. Further studies could quantify potential benefit of this model which seems best suited for bundled payment and population management type strategies.