PROCESS IMPROVEMENTS REDUCE UTILIZATION OF RESOURCES FOR AORTIC-ANEURYSM REPAIR

In conjunction with the VA reorganization to promote greater efficienc y of health care provision, ambulatory surgery (AS) programs have been created. These programs institute outpatient preoperative assessment and operative management. This study examines the impact of these proc ess changes on resources utilized by patients requiring repair of abdo minal aortic aneurysms (AAAs). The medical records of 15 consecutively treated patients undergoing elective, infrarenal AAA repair before (1 992-1993) and after (1995-1996) AS implementation were reviewed. Resou rce utilization was assessed by evaluating preoperative tests performe d (inpatient or outpatient), ICU days, and inpatient length of stay (L OS). Postoperative morbidity and mortality were noted. Patient age, AA A size, and prevalence of diabetes mellitus, hypertension, cardiac dis ease, COPD, and tobacco use were similar between the two groups. Abdom inal ultrasound, CT scanning, and angiography were significantly more frequently performed on an outpatient basis after implementation of th e AS program. The median preoperative LOS was reduced in the AS group (1 vs 6 days, P = 0.001, Student t test), resulting in a lower inpatie nt LOS (11 vs 16, P < 0.01, Student t test), All patients survived and the incidence of complications was similar between the groups. Hospit al resource utilization was significantly decreased, largely by shifti ng preoperative assessment to the outpatient setting. This study illus trates that benefits of an ambulatory surgery program can be extended beyond facilitating outpatient operations and should result in decreas ed length of hospitalization for other major surgical procedures, such as abdominal aortic aneurysm repair. (C) 1998 Academic Press.