Change in policy allowing overlapping surgery decreases length of stay in an academic, safety net hospital

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Anthony DiGiorgio

A change in policy allowing overlapping surgery decreases length of stay in an academic, safety net hospital. This is the conclusion of Anthony DiGiorgio (Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans; Department of Neurosurgery, University of California, San Francisco, USA), winner of the Robert Florin Award, presented during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting (28 April–2 May, New Orleans, USA).

As the practice of surgeons performing overlapping surgery has recently come under scrutiny, this research sought to examine the impact of hospital policy that allows overlapping rooms on surgery wait time and length of stay in patients admitted to a tertiary care, safety net hospital for urgent neurosurgical procedures.

The neurosurgery service at the hospital being studied transitioned from routinely allowing one room per day (period one) to overlapping rooms (period two), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Case urgency, patient demographics, case type, indication, length of stay and time from admission to surgery were tracked.

Per study results, allowing overlapping rooms significantly reduced length of stay, complication rate and increased the rate of discharges to home. This was in a vulnerable population, comprised mostly of Medicare, Medicaid and uninsured patients who were in need of urgent surgery at a single safety-net academic institution.

There were 452 total cases reviewed (201 in period one, 251 in period two), covering seven months in each period. There were 122 cases classified as “urgent” (59 in period one, 63 in period two). In these patients, length of stay was significantly decreased in period two (13.09 days vs. 19.52) and the time from admission to surgery for urgent cases trended towards a shorter time (5.12 vs. 7.00). Insurance status of these patients was 26.2% uninsured, 39.3% Medicaid, 18.9% Medicare, 9% commercial, and the remainder workers compensation, liability or prisoner care. Wait time significantly correlated with length of stay.

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