Robot-assisted and conventional urology surgical procedures: comparison of average length of stay, economic status, operative time and patient's expenditure in a tertiary care hospital of North India

Robot-assisted surgeries allows the surgeons to operate using remote-controlled robotic arms that are more effective in comparison to conventional (open/laparoscopic) surgeries. However, there is substantial lack of evidence on the effectiveness of robot-assisted surgeries in low to middle income countries (LMICs) like India. A study was conducted with an aim to evaluate the average length of stay (ALOS), Operative time, economic status (patient's) and cost borne by the patient (patient's expenditure) for undergoing robot-assisted surgeries and conventional surgeries. Grouping of the surgical procedures was done wherein patients who were treated with robot-assisted surgical procedures were placed in Group-01 whereas those treated with conventional surgical procedures were placed under Group-02. Comparative evaluation of the two surgical groups revealed that in robot-assisted surgical procedure, the ALOS was less (18.43 vs. 23.14 days, p = 0.06) whereas operative time (316.7 vs. 252.63 min, p = 0.05) and patient's expenditure were more (INR 70,654.29 vs. INR 41,314.73, p = 0.00). However, there was no significant difference between the economic statuses of patients in both groups. The study concluded that in this era of rapidly expanding health care scenario; targeted, regular, rigorous and repeated training programmes in future may shorten the learning curve thereby paving a way to reduce the cost as well as the operative time of robot-assisted surgeries in LMICs.

Determining Efficacy of Inpatient Care for Select Surgeries at a Large Tertiary Care Hospital With Average Length of Stay as a Measure

The purpose of the study was to determine average length of stay (ALOS) for selected surgical procedures for CABG, TKR, THR and inguinal hernia and to compare the variation of ALOS among the group and its comparison with standard guidelines. Passive file auditing method was followed to collect the required information to calculate the pre-operative, post- operative and overall LOS for a period of two months. Additional data was collected from electronic health record system used by the hospital. The observed value for ALOS for CABG was 12.76 days, for TKR - 6.44 days, THR-7.6 days and for inguinal hernia, it came to 2.28 days. Further, the mean and standard deviation with respect to pre-operative and post-operative stay for the four surgical procedures revealed mean pre-operative stay for CABG was 3.96 days, TKR - 1.18 days, THR- 1.60 days and Inguinal hernia was 0.53 days. The post-operative mean stay for CABG, TKR, THR and inguinal hernia were 8.80 days, 4.98 days, 6 days and 1.77 days respectively. It was also observed that there was difference in terms of length of stay (LOS) when compared between male and female patients for different surgical procedures. The findings help in identifying the factors leading to increased LOS number of cases with pre-operative, post-operative or overall stay from entry to exit. It has given an insight on the gaps that needs to address to improve the efficiency of patient services offered by the tertiary care hospital.

Assessing the performance of hospitals before and after the implementation of Iran's Health Sector Evolution Plan (HSEP) using the Pabon Lasso model

Background: The health sector evolution plan was implemented in 2014 in government hospitals across the country as a part of the universal health coverage achievement programs. This study assessed the performance of hospitals before and after the implementation of this plan, using the Pabon Lasso model. Methods: The population of this study consisted of the hospitals of the country in the 2013-2015 time frame; overall, 874 hospitals (94.5% of the population) were included in the study. In order to assess performance, we used the Pabon Lasso model and hospital performance indicators (Average Length of Stay, Bed Turnover, and Bed Occupancy Rate). The data were collected from the Hospital Information System and provincial deputies of curative affairs and were then analyzed using the descriptive indicators of mean, frequency, and median in SPSS 22. Also, Paired Student T-test and ANOVA were used to compare the performance of different groups of hospitals before and after the implementation of the health sector evolution plan. Results: The implementation of the health sector evolution plan has led to a significant improvement in the three performance indicators in the hospitals of the country. Before the implementation of the health sector evolution plan, the most inefficient, inefficient, fairly efficient, and most efficient zones included 31%, 18%, 17%, and 33% of the studied hospitals, respectively. However, the implementation of the health sector evolution plan changed the percentages to 29%, 21%, 20%, and 30%, respectively. Teaching hospitals, which are governmental and are mostly located in capital cities of the provinces, were overall more inefficient than non-teaching hospitals. Conclusion: The number of the most efficient and most inefficient hospitals has decreased, and the number of average performance hospitals has increased after the implementation of the health sector evolution plan. Therefore, the health sector evolution plan has not led to an overall increase or decrease in the performance of hospitals but has reduced the difference in the performance of hospitals. Equal support of government hospitals along with financial protection against health expenses, improves the performance indicators of hospitals and reduces performance differences among them.

Process and Results of Implementing Disease Management Program in Patients with First-time Ischemic Stroke

BACKGROUND

This study aimed to examine the effect of disease management program (DMP) on the patients with first-time ischemic stroke (IS).

METHODS

A DMP with 4 parts of performance indicators (PIs, including outpatient, emergency department, inpatient and follow-up treatment) was implemented in patients with stroke in 2 hospitals (Hospital T and R) in Shanghai China from 2007-2010. The effect of DMP on the outcome of IS patients was analyzed according to the criteria of the National Institute of Health Stroke Scale (NIHSS). Furthermore, the total effective rate of DMP, average length of stay, hospitalization cost, and cost-effectiveness ratio (CER) between DMP and non-DMP patients were calculated, followed by the cost-effectiveness analysis.

RESULTS

The total effective rate of DMP (T: 69.9%; R: 76.6%) was significantly (P<0.05) higher than that of non-DMP (T: 60.8%; R: 62.7%) group in the same hospital. In addition, a significant (P<0.05) difference in effective rate was observed between DMP and non-DMP at the NIHSS score ≥ 7. Furthermore, the average length of stay and hospitalization cost of the patients in DMP group were significantly (P<0.05) lower than those in non-DMP group. A superior CER was also found in DMP group than non-DMP group.

CONCLUSION

The implementation of DMP for IS can effectively improve the treatment outcome and reduce the average length of stay and hospitalization cost.