Background: There are approximately 30 million major inpatient surgeries annually. The cost of inpatient surgery has increased over the last decade; the average hospitalization for surgery was $13,000 in 2000 and increased to $18,000 in 2010. Policy-makers and hospital administrators have sought to implement interventions that contain and/or lower the costs associated with hospitalizations. The concept of perioperative surgical home (PSH) is becoming increasingly popular. PSH is defined as “an innovative, patient-centered, surgical continuity of care model that incorporates shared decision making.” In the PSH model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge. This study will examine the clinical outcomes associated with implementation of a PSH among spine patients at a tertiary hospital. Methods: The perioperative surgical home was implemented by the Department of Anesthesiology and included preoperative, intraoperative, and postoperative care by Anesthesiology team. The care included perioperative risks assessment, pain and PONV management, and other aspects of perioperative care which could be used as a simple tool for reducing the incidences of postoperative complications and shortening hospitalization. . The PSH was implemented at Cedars-Sinai Medical Center (CSMC) from 2014 to 2016 among patients undergoing a variety of spine cases including fusions, laminectomies, and decompressions. A control group from CSMC with similar procedures and surgical staff was also included in the study. There were 651 PSH patients included in the analyses; 651 control patients were selected based on gender and date of admission. The sample was 51% female, 85% white, the average age of the sample was 58.4 (SD = 14.7), and 66% of the sample was ASA class I or II; there were no differences between PSH and control patients in regards to age, gender, or ASA class (p > .05). The primary outcomes that will be examined are length of stay, admission to the intensive care unit following surgery, and readmission to the hospital within 30 days. Secondary outcomes include postoperative urinary tract infection, postoperative pneumonia, prolonged mechanical ventilation, and unplanned postoperative intubation. Results: There were no differences in length of stay following surgery between the PSH and the control patients (Mean = 3.8 days, SD = 3.2; Mean = 3.9, SD = 5.0; p = .771, respectively). There were also no differences in ICU admission following surgery between the PSH and control group (5.7% among PSH, 7.2% among control group, p = .259). The PSH group had fewer ICU readmission in 30 days as compared to the control group (1.5% in PSH, 3.4 in control group, p = .032). Conclusions: This study did not find differences in length of stay or ICU admission after surgery, however, there was a lower rate of ICU readmission among the PSH patients as compared to the control patients. Implications for the PSH will be discussed.
