Abstract

Background With the United States’ healthcare system shifting towards a performance- and outcomes- based delivery model, attention must be turned towards improving patient experiences and population health while reducing costs and expenditures. The Perioperative Surgical Home model, led by the American Society of Anesthesiologists, aims to achieve these goals for patients during the perioperative period. We introduced this concept at our institution through establishing an Anesthesiology-centered preoperative evaluation program for patients undergoing elective urologic procedures. In doing so, we hypothesized that preoperative testing procedures and their associated expenses would be significantly reduced while surgical outcomes and adverse events would not be affected. Methods: We performed a single institution retrospective chart review of all patients who were evaluated at the preoperative anesthesia clinic in preparation for elective urologic surgery in the year before and after implementation of our preoperative evaluation program (February 1, 2012). Testing and procedures obtained after this time for pre-operative evaluation were individually guided by patients’ history, symptoms, and extent of surgery. Results: One thousand and twenty patients (504 patients before and 516 after program implementation) were identified and reviewed. There was a statistically significant reduction in the quantity of laboratory, radiologic, and electrocardiographic studies performed with an associated financially significant decrease in associated hospital charges. No differences were seen between the groups for surgical outcomes, adverse events, and hospital efficiency measures. Conclusions The implementation of an Anesthesiology-centered preoperative evaluation program decreased the quantity of testing procedures and their associated hospital charges without negatively affecting surgical outcomes, adverse events, or hospital efficiency measures. While our experience only focuses on the preoperative phase, our results suggest that the Perioperative Surgical Home concept can lead to better patient experiences, improve outcomes, and reduced expenditures.