Same-day admissions and other cost-saving strategies for elective aortoiliac surgery

Purpose: We retrospectively analyzed whether same-day admissions and other resource utilization methods for patients undergoing elective infrarenal aortoiliac surgery (AoIS) were safe and cost-effective. Methods: Morbidity and mortality rates and costs were compared between 71 patients admitted before the day of surgery (group I) and 57 patients admitted the day of surgery (group II) who underwent elective AoIS between July 1, 1992, and December 31, 1995. After January 1, 1994, a concerted effort was made to decrease hospital costs by performing out-patient preoperative assessment, admitting patients the morning of surgery, and planning early discharge through implementation of clinical pathways. Patients were excluded (total, 33; 20%) from analysis if they were admitted before the day of surgery for intravenous hydration (5), optimizing cardiac function (4), or prolonged preoperative antibiotics (2), or if they required emergency surgery (10) or were transferred from another service or hospital(12). After exclusion, there were no significant differences (p >0.05) between groups I and II in terms of age, sex, race, diabetes, hypertension, pulmonary disease, cardiac disease, renal insufficiency, type of incision (midline or retroperitoneal), indication for surgery (aneurysm or occlusive disease), or inflow site (aorta or common iliac artery). Results: There were no significant differences between groups I and II in terms of mortality rate (0%); cardiac (1.4% [1/7I] vs 0%), pulmonary (9.9% [7/71] vs 5.3% [3/57]), or renal (1.4% [1/71] vs 0%) complications; or readmission rates within 30 days (5.6% [4/71] vs 5.2% [3/57]), respectively (P >0.05). There were significant decreases in length of hospital stay (mean, 6.4 vs 11.2 days; p <0.0001) and hospital cost per patient ($34,198 vs $45,694; p=0.001) for group II compared to group I, respectively. Conclusions: The majority of patients who require elective infrarenal aortoiliac surgery can be admitted the day of surgery and undergo early discharge with significant hospital cost savings and without apparent increase in morbidity or mortality rates.