Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Anesthesia/OR Economics
The American Society of Anesthesiologists task force for value-based anesthesia care states: "The least expensive strategy for obtaining the acceptable outcome is the optimal value-based anesthetic." Recently we have implemented a clinical pathway for patients undergoing radical retropubic prostatectomy. We describe the effect of these changes on hospital costs, length of stay and patient satisfaction.
The setting is a tertiary care teaching facility. The clinical pathway implemented three major changes in the care of patients undergoing radical retropubic prostatectomy. First, patients were no longer encouraged to predonate autologous blood. Second, the method of postoperative analgesia was changed from a continuous epidural infusion of 0.1% bupivicaine and 5mcg/cc fentanyl to a single dose of epidural morphine (3 or 4 mg) administered near the end of the surgery. Third, patients were encouraged to eat and ambulate as soon as the evening of surgery; postoperative nursing goals were clearly defined.
Satisfaction surveys  were sent to all patients after surgery. Cost data were collected using the TSI billing and cost allocation system. Student's t-test with unequal variances was used to compare groups with a p<0.05 considered significant. Because there was a trend toward shorter hospital stays for patients on the clinical pathway, a stepwise linear regression was performed to determine if the mode of analgesia was independently associated with reduced cost even after the effect of shorter stays was considered.
Between 4/5/96 and 2/14/97, 73 patients returned complete analyzable satisfaction surveys (86% response rate). The clinical pathway was started on 9/5/96. 28 patients were on the pathway and 45 patients were not. Hospital costs, and length of stay were significantly reduced while patient satisfaction remained unchanged (Table 1). Multiple regression demonstrates that single-dose epidural morphine is associated with significantly decreased cost independent of length of stay (Table 2).
By developing a clinical pathway centered upon accelerated ambulation and feeding with the use of epidural morphine for postoperative analgesia we were able to significantly reduce hospital costs and length of stay in this group of patients undergoing radical retropubic prostatectomy. We were able to achieve these cost savings without negatively effecting patient satisfaction, demonstrating true value-based care.
© 1998 International Anesthesia Research Society
1. In Anesthesia & Analgesia, 1997; 84:S193