Healthcare spending and utilization following antireflux surgery: examining costs and reasons for readmission

Same-Day Home Recovery for Benign Foregut Surgery

Importance

Same-day home recovery (SHR) is now the standard of care for many major surgical procedures and has the potential to become standard practice for benign foregut procedures (eg, hiatal hernia repair, fundoplication, and Heller myotomy).

Objective

To determine whether SHR for patients undergoing benign foregut surgery is feasible, safe, and effective.

Design, Setting, and Participants

This prospective cohort study took place across 19 medical centers within an integrated health care system in northern California from January 2019 through September 2021. Participants included consecutive patients undergoing elective benign foregut surgery.

Exposures

Standardized SHR program.

Main Outcomes and Measures

The primary end point was the rate of SHR. The secondary end points were 7-day and 30-day rates of postoperative emergency department visits, hospital readmissions, and reoperations.

Results

Of 1248 patients who underwent benign foregut surgery from January 2017 through September 2021, 558 were patients before implementation of the SHR program and 690 were patients postimplementation. The mean age of patients was 60 years, and 759 (59%) were female. The preimplementation SHR rate was 64 of 558 patients (11.5%) in 2018 and increased to 82 of 113 patients (72.6%) by 2021 (94/350 [26.9%] in 2019 and 112/227 [49.3%] in 2020; P < .001). There were no statistical differences in the 7-day and 30-day rates of postoperative emergency visits, hospital readmissions, and reoperations or 30-day mortality in the SHR vs non-SHR groups in the postimplementation era.

Conclusions and Relevance

In this study, implementation of a regional SHR program among patients undergoing elective benign foregut surgery was feasible, safe, and effective. The changes in perioperative care require comprehensive patient education and full multidisciplinary support. An SHR program for benign foregut procedures has the potential to improve patient care and cost-effectiveness in care delivery.

Examining emergency department utilization in the post-foregut surgery patient

BACKGROUND

The purpose of this study was to examine emergency department (ED) utilization following minimally invasive foregut surgery and determine its impact on costs. Furthermore, we sought to determine their relationship to the index procedure, whether they are preventable, and describe strategies for decreasing unnecessary ED visits.

METHODS

A retrospective review was conducted for all patients undergoing foregut procedures from January 2018 through June 2019. ED utilization was examined from 0 to 90 days. The proportion of visits related to surgery, preventable visits, and median ED costs were compared between visits occurring 0-30 days (early) versus 31-90 days (delayed) postoperatively as well as occurring from 8 am to 5 pm versus 5 pm to 8 am.

RESULTS

Of 458 patients who underwent foregut surgery, 72.5% were female and the mean age was 60 years old. 92 patients (20%) presented to the ED within 90 days. Of these, 59 patients (64.1%) presented to the ED early versus 33 patients (35.9%) delayed. 56.5% of ED visits occurred during clinic hours. 56 (60.9%) ED visits were related to the procedure and 20 (35.7%) were preventable. The median ED return cost was $970. Early ED visits were significantly more likely to be related to surgery (72.9% vs 39.4%, p = 0.0016). There was no significant difference in the proportion of visits that were preventable (32.6% vs 46.2%, p = 0.3755) and ED return cost did not vary significantly ($995 vs $965, p = 0.43) between early and delayed visits.

CONCLUSIONS

ED visits are common after foregut surgery and represent a financial burden on healthcare. Most visits occur early and are more likely to be related to surgery. Importantly, more than one-third of ED visits related to surgery were preventable and most occurred during clinic hours on weekdays. Providers should consider implementation of strategies to improve outpatient utilization and decrease unnecessary ED visits.