Outpatient air leak management after lobectomy: A CMS cost analysis

Ryan K. Schmocker, David Vanness, Ryan A. MacKe, Shahab A. Akhter, James D. Maloney, Justin D. Blasberg

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Air leaks after lobectomy are associated with increased length of stay (LOS) and protracted resource utilization. Portable drainage systems (PDS) allow for outpatient management of air leaks in patients otherwise meeting discharge criteria. We evaluated the safety and cost efficiency of a protocol for outpatient management of air leaks with a PDS. Methods We retrospectively assessed patients who underwent lobectomy for non-small-cell lung cancer at our institution between 2004 and 2014. All patients discharged with a PDS for air leak were included in the analysis. The study group was compared to an internally matched cohort of patients undergoing lobectomy for non-small-cell lung cancer managed without the need for outpatient PDS. Study end points included resource utilization, postoperative complications, and readmission. Results A total of 739 lobectomies were performed during the study period, 73 (10%) patients with air leaks were discharged with a PDS after fulfilling postoperative milestones. Shorter LOS was observed in the study group (3.88 ± 2.4 versus 5.68 ± 5.7 d, P = 0.014) without significant differences in 30-d readmission (11.7% versus 9.0%, P = 0.615). PDS-related complications occurred in 6.8% of study patients (5/73), and 2.7% (2/73) required overnight readmission. PDSs were used for 8.30 ± 4.5 outpatient days. A CMS-based cost analysis predicted an overall savings of $686.72/patient (4.9% of Medicare reimbursement for a major thoracic procedure), associated with significantly fewer hospital days and resources used. Conclusions In patients otherwise meeting discharge criteria, outpatient management of air leaks is safe and effective. This strategy is associated with improved efficiency of postoperative care and a modest reduction in hospital costs. This model may be applicable to other thoracic procedures associated with protracted LOS.

Original languageEnglish (US)
Pages (from-to)390-397
Number of pages8
JournalJournal of Surgical Research
Volume203
Issue number2
DOIs
StatePublished - Jun 15 2016

Fingerprint

Outpatients
Air
Costs and Cost Analysis
Drainage
Length of Stay
Non-Small Cell Lung Carcinoma
Thorax
Postoperative Care
Hospital Costs
Medicare
Safety

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Schmocker, R. K., Vanness, D., MacKe, R. A., Akhter, S. A., Maloney, J. D., & Blasberg, J. D. (2016). Outpatient air leak management after lobectomy: A CMS cost analysis. Journal of Surgical Research, 203(2), 390-397. https://doi.org/10.1016/j.jss.2016.03.043
Schmocker, Ryan K. ; Vanness, David ; MacKe, Ryan A. ; Akhter, Shahab A. ; Maloney, James D. ; Blasberg, Justin D. / Outpatient air leak management after lobectomy : A CMS cost analysis. In: Journal of Surgical Research. 2016 ; Vol. 203, No. 2. pp. 390-397.
@article{1bdb5902ba5e4837ba9d9e55eef4440b,
title = "Outpatient air leak management after lobectomy: A CMS cost analysis",
abstract = "Background Air leaks after lobectomy are associated with increased length of stay (LOS) and protracted resource utilization. Portable drainage systems (PDS) allow for outpatient management of air leaks in patients otherwise meeting discharge criteria. We evaluated the safety and cost efficiency of a protocol for outpatient management of air leaks with a PDS. Methods We retrospectively assessed patients who underwent lobectomy for non-small-cell lung cancer at our institution between 2004 and 2014. All patients discharged with a PDS for air leak were included in the analysis. The study group was compared to an internally matched cohort of patients undergoing lobectomy for non-small-cell lung cancer managed without the need for outpatient PDS. Study end points included resource utilization, postoperative complications, and readmission. Results A total of 739 lobectomies were performed during the study period, 73 (10{\%}) patients with air leaks were discharged with a PDS after fulfilling postoperative milestones. Shorter LOS was observed in the study group (3.88 ± 2.4 versus 5.68 ± 5.7 d, P = 0.014) without significant differences in 30-d readmission (11.7{\%} versus 9.0{\%}, P = 0.615). PDS-related complications occurred in 6.8{\%} of study patients (5/73), and 2.7{\%} (2/73) required overnight readmission. PDSs were used for 8.30 ± 4.5 outpatient days. A CMS-based cost analysis predicted an overall savings of $686.72/patient (4.9{\%} of Medicare reimbursement for a major thoracic procedure), associated with significantly fewer hospital days and resources used. Conclusions In patients otherwise meeting discharge criteria, outpatient management of air leaks is safe and effective. This strategy is associated with improved efficiency of postoperative care and a modest reduction in hospital costs. This model may be applicable to other thoracic procedures associated with protracted LOS.",
author = "Schmocker, {Ryan K.} and David Vanness and MacKe, {Ryan A.} and Akhter, {Shahab A.} and Maloney, {James D.} and Blasberg, {Justin D.}",
year = "2016",
month = "6",
day = "15",
doi = "10.1016/j.jss.2016.03.043",
language = "English (US)",
volume = "203",
pages = "390--397",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "2",

}

Schmocker, RK, Vanness, D, MacKe, RA, Akhter, SA, Maloney, JD & Blasberg, JD 2016, 'Outpatient air leak management after lobectomy: A CMS cost analysis', Journal of Surgical Research, vol. 203, no. 2, pp. 390-397. https://doi.org/10.1016/j.jss.2016.03.043

Outpatient air leak management after lobectomy : A CMS cost analysis. / Schmocker, Ryan K.; Vanness, David; MacKe, Ryan A.; Akhter, Shahab A.; Maloney, James D.; Blasberg, Justin D.

In: Journal of Surgical Research, Vol. 203, No. 2, 15.06.2016, p. 390-397.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outpatient air leak management after lobectomy

T2 - A CMS cost analysis

AU - Schmocker, Ryan K.

AU - Vanness, David

AU - MacKe, Ryan A.

AU - Akhter, Shahab A.

AU - Maloney, James D.

AU - Blasberg, Justin D.

PY - 2016/6/15

Y1 - 2016/6/15

N2 - Background Air leaks after lobectomy are associated with increased length of stay (LOS) and protracted resource utilization. Portable drainage systems (PDS) allow for outpatient management of air leaks in patients otherwise meeting discharge criteria. We evaluated the safety and cost efficiency of a protocol for outpatient management of air leaks with a PDS. Methods We retrospectively assessed patients who underwent lobectomy for non-small-cell lung cancer at our institution between 2004 and 2014. All patients discharged with a PDS for air leak were included in the analysis. The study group was compared to an internally matched cohort of patients undergoing lobectomy for non-small-cell lung cancer managed without the need for outpatient PDS. Study end points included resource utilization, postoperative complications, and readmission. Results A total of 739 lobectomies were performed during the study period, 73 (10%) patients with air leaks were discharged with a PDS after fulfilling postoperative milestones. Shorter LOS was observed in the study group (3.88 ± 2.4 versus 5.68 ± 5.7 d, P = 0.014) without significant differences in 30-d readmission (11.7% versus 9.0%, P = 0.615). PDS-related complications occurred in 6.8% of study patients (5/73), and 2.7% (2/73) required overnight readmission. PDSs were used for 8.30 ± 4.5 outpatient days. A CMS-based cost analysis predicted an overall savings of $686.72/patient (4.9% of Medicare reimbursement for a major thoracic procedure), associated with significantly fewer hospital days and resources used. Conclusions In patients otherwise meeting discharge criteria, outpatient management of air leaks is safe and effective. This strategy is associated with improved efficiency of postoperative care and a modest reduction in hospital costs. This model may be applicable to other thoracic procedures associated with protracted LOS.

AB - Background Air leaks after lobectomy are associated with increased length of stay (LOS) and protracted resource utilization. Portable drainage systems (PDS) allow for outpatient management of air leaks in patients otherwise meeting discharge criteria. We evaluated the safety and cost efficiency of a protocol for outpatient management of air leaks with a PDS. Methods We retrospectively assessed patients who underwent lobectomy for non-small-cell lung cancer at our institution between 2004 and 2014. All patients discharged with a PDS for air leak were included in the analysis. The study group was compared to an internally matched cohort of patients undergoing lobectomy for non-small-cell lung cancer managed without the need for outpatient PDS. Study end points included resource utilization, postoperative complications, and readmission. Results A total of 739 lobectomies were performed during the study period, 73 (10%) patients with air leaks were discharged with a PDS after fulfilling postoperative milestones. Shorter LOS was observed in the study group (3.88 ± 2.4 versus 5.68 ± 5.7 d, P = 0.014) without significant differences in 30-d readmission (11.7% versus 9.0%, P = 0.615). PDS-related complications occurred in 6.8% of study patients (5/73), and 2.7% (2/73) required overnight readmission. PDSs were used for 8.30 ± 4.5 outpatient days. A CMS-based cost analysis predicted an overall savings of $686.72/patient (4.9% of Medicare reimbursement for a major thoracic procedure), associated with significantly fewer hospital days and resources used. Conclusions In patients otherwise meeting discharge criteria, outpatient management of air leaks is safe and effective. This strategy is associated with improved efficiency of postoperative care and a modest reduction in hospital costs. This model may be applicable to other thoracic procedures associated with protracted LOS.

UR - http://www.scopus.com/inward/record.url?scp=84969540930&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84969540930&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2016.03.043

DO - 10.1016/j.jss.2016.03.043

M3 - Article

C2 - 27363648

AN - SCOPUS:84969540930

VL - 203

SP - 390

EP - 397

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

ER -