Abstract
Purpose :
Cataract surgery is the most common surgical procedure in the United States, and complications are exceedingly rare. Pre-operative testing has not been shown to decrease operative risk, however it is still routinely performed. At Harbor-UCLA Medical Center, a Los Angeles County Hospital, an expedited pre-operative pathway allows low-risk patients to forego standard laboratory tests and imaging and complete an anesthesia evaluation by telephone. With this current study, we evaluate the financial impact of the expedited pathway versus standard pre-operative care.
Methods :
A retrospective chart review was performed from January to August of 2018. Each expedited case was matched by anesthesia type and operating team to a control. Pre-operative laboratory work-up, duration of anesthesia evaluation, and operating room (OR) times were recorded. Standardized pre-operative and OR costs were obtained from the Centers for Medicare and Medicaid Services (CMS) reimbursement rates. Pre-operative anesthesia evaluation costs were based on facility anesthesiologist salaries.
Results :
Fifty-seven patients met expedited pathway inclusion criteria. Pre-operative evaluation cost an average of $29.38 per expedited case, versus $150.20 for a standard case, a reduction of 80.46%. Expedited cases required an average OR turnover time of 32.5 min (95% CI 27.46 – 37.56) and a procedure time of 26.4 min (95% CI 23.5 – 29.3), compared to OR turnover of 30.5 min (95% CI 26.6 – 34.3) and procedure duration of 32.5 min (95% CI 27.2 – 37.8) for standard cases. No statistically significant differences were identified. The peri-operative costs were calculated based on the value of OR time; expedited cases averaged $1,185.92, versus $1,217.56 for standard cases. As no significant post-operative complications were identified, neither pathway incurred additional post-operative costs. In total, expedited cases cost $1,215.30 per case, compared to $1,367.76 for standard cases, an 11.15% decrease in cost. Operative outcomes and rates of complications were equal in both groups.
Conclusions :
Routine pre-operative testing in otherwise healthy patients has been shown to be of little value prior to cataract surgery. A cost analysis revealed that the expedited pathway resulted in a savings of $152.46 per case, an 11.15% decrease in overall costs compared to a standard pre-operative workup, with no change in intra- or post-operative complication rates.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.