Perioperative surgical homes and improving results for patients and hospitals

UCI Health anesthesiologists spearhead effort 

October 31, 2014

UCI Health physicians continue to be leaders for a model of surgical care that may drive down hospital costs and, more importantly for patients, results in better outcomes and fewer complications.

At the recent annual meeting of the American Society of Anesthesiologists, Dr. Zeev Kain discussed the perioperative surgical home concept and UC Irvine’s experience in front of more than 5,000 participants during the meeting’s opening session. 

“The perioperative surgical home delivers better patient outcomes, enhances safety and reduces costs,” said Kain, MD, MBA, and professor with the UC Irvine Department of Anesthesiology & Perioperative Care and Chancellor’s Professor of Anesthesiology, Pediatrics and Psychiatry. “That’s not wishful thinking, it’s hard data.”

“Readmission rates are between 8 and 12 percent for the U.S. Our readmission rate from the [perioperative surgical home] is 0.5 percent,” he said.

Noting that half of all hospital costs occur in the postoperative period, Kain said avoidable complications such as pneumonia, urinary tract infections or the delirium some patients experience as they emerge from anesthesia can add $10,000 to the cost of treatment.

In addition, UCI Health anesthesiologists made more than two dozen presentations, including Minimizing Postoperative ICU Complications with Drs. Trung Q. Vu and William Wilson, Optimization of the High-Risk Surgery Patient in the Era of Enhanced Recovery After Surgery and Perioperative Surgical Home with Dr. Maxime Cannesson and Kain, and Total Joint Perioperative Surgical Home at UCI Health: A Cost Analysis with Drs. Darren R. Raphael, Cannesson, Leslie M. Garson, Shermeen B. Vakharia, Kain, Ran Schwarzkopf and Ranjan Gupta.

This perioperative care model, which refers to the period before, during and after surgery, spans the patient’s entire surgical experience, starting with the decision to have surgery through 30 to 90 days after hospital discharge.  The care pathway is a mapped out by a clinical team that includes surgeons, anesthesiologists, nurses and to the medical device specialists to the rehabilitation therapists, such that there is complete continuity of care as well as standardization of practices to enhance patient safety. 

Kain and Cannesson summed up the reasons for their surgical home efforts in the May issue of the journal Anesthesia & Analgesia:

Interestingly, with the recent changes occurring in the health care system in the United States, the American Society of Anesthesiologists has endorsed the concept of the Perioperative Surgical Home (PSH) and has recommended including it as part of affordable care organizations and hospitals. It is widely recognized that our current perioperative system in the United States is costly, fragmented, and often driven by focus on hospital reimbursement as well as culture and tradition rather than on quality and service. … Because it has been shown that most perioperative complications are related to a lack of coordination of care and a wide variability in the way care is delivered, a model such as the PSH is much needed.

UCI Health physicians published several other articles about the perioperative surgical home in the May Anesthesia & Analgesia, including a review of the university’s experience with orthopaedic surgeon Schwarzkopf and the model’s implementation for total hip and total knee replacement surgeries.

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