Effectiveness of a postoperative disposition protocol for sleep apnea surgery
Abstract Purpose 1) Evaluate the effectiveness of a postoperative disposition protocol for upper airway surgery in patients with sleep apnea. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery versus surgical intensive care admission determined by preoper...
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| Veröffentlicht in: | American journal of otolaryngology 2013-07, Vol.34 (4), p.273-277 |
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| creator | Rocke, Daniel, MD, JD Sharp, Scott, MD Wiener, Dana, MD Puscas, Liana, MD Lee, Walter T., MD |
| description | Abstract Purpose 1) Evaluate the effectiveness of a postoperative disposition protocol for upper airway surgery in patients with sleep apnea. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery versus surgical intensive care admission determined by preoperative screening criteria. Materials and methods A new preoperative protocol for sleep apnea surgery was instituted at the Durham Veterans Affairs Medical Center in 2008 to triage patients undergoing sleep apnea surgery to one of three postoperative dispositions: intensive care, routine ward bed, or discharge home. An Institutional Review Board approved retrospective chart review of patients undergoing sleep apnea surgery between May 2008 and January 2012 was performed. Postoperative complications and cost comparisons were assessed between each of the three postoperative disposition groups. Results 115 patients underwent sleep apnea surgery between July 2008 and January 2012. 11 patients were excluded leaving 104 patients in the final analysis. Median follow-up was 1.25 months. Overall complication rate was 12.5%. Eight complications occurred in the group triaged to intensive care, and 5 occurred in those triaged to lesser levels of postoperative care. All serious complications occurred during the immediate postoperative period. Based on only room charges, $125,275 was saved over the 3.6 years of this study. Conclusion A post operative disposition protocol can be effectively used to triage patients to less than intensive postoperative care. In institutions like the Durham VA, where sleep apnea patients were routinely triaged to intensive care, postoperative resources will be more efficiently utilized. |
| doi_str_mv | 10.1016/j.amjoto.2012.11.017 |
| format | Article |
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Materials and methods A new preoperative protocol for sleep apnea surgery was instituted at the Durham Veterans Affairs Medical Center in 2008 to triage patients undergoing sleep apnea surgery to one of three postoperative dispositions: intensive care, routine ward bed, or discharge home. An Institutional Review Board approved retrospective chart review of patients undergoing sleep apnea surgery between May 2008 and January 2012 was performed. Postoperative complications and cost comparisons were assessed between each of the three postoperative disposition groups. Results 115 patients underwent sleep apnea surgery between July 2008 and January 2012. 11 patients were excluded leaving 104 patients in the final analysis. Median follow-up was 1.25 months. Overall complication rate was 12.5%. Eight complications occurred in the group triaged to intensive care, and 5 occurred in those triaged to lesser levels of postoperative care. All serious complications occurred during the immediate postoperative period. Based on only room charges, $125,275 was saved over the 3.6 years of this study. Conclusion A post operative disposition protocol can be effectively used to triage patients to less than intensive postoperative care. In institutions like the Durham VA, where sleep apnea patients were routinely triaged to intensive care, postoperative resources will be more efficiently utilized.</description><identifier>ISSN: 0196-0709</identifier><identifier>EISSN: 1532-818X</identifier><identifier>DOI: 10.1016/j.amjoto.2012.11.017</identifier><identifier>PMID: 23332409</identifier><identifier>CODEN: AJOTDP</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Ambulatory Care - economics ; Ambulatory Care - statistics & numerical data ; Body mass index ; Cardiovascular disease ; Chronic obstructive pulmonary disease ; Cohort Studies ; Coronary vessels ; Cost control ; Cost Savings ; Cost-Benefit Analysis ; Female ; Follow-Up Studies ; Heart failure ; Hospitalization - economics ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Hypertension ; Incidence ; Intensive care ; Laryngoplasty - methods ; Male ; Middle Aged ; Narcotics ; Otolaryngology ; Postoperative Care - standards ; Postoperative Complications - epidemiology ; Postoperative Complications - physiopathology ; Postoperative period ; Preoperative Care - methods ; Retrospective Studies ; Risk Assessment ; Risk factors ; Severity of Illness Index ; Sleep apnea ; Sleep Apnea Syndromes - diagnosis ; Sleep Apnea Syndromes - surgery ; Sleep disorders ; Surgery ; Treatment Outcome ; Triage - methods ; United States ; Veterans</subject><ispartof>American journal of otolaryngology, 2013-07, Vol.34 (4), p.273-277</ispartof><rights>2013</rights><rights>Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-43f69bc6c73e5a79801c7d3f440a13dc4039a074fa1b6cd614a087f13ddd200f3</citedby><cites>FETCH-LOGICAL-c445t-43f69bc6c73e5a79801c7d3f440a13dc4039a074fa1b6cd614a087f13ddd200f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjoto.2012.11.017$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23332409$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rocke, Daniel, MD, JD</creatorcontrib><creatorcontrib>Sharp, Scott, MD</creatorcontrib><creatorcontrib>Wiener, Dana, MD</creatorcontrib><creatorcontrib>Puscas, Liana, MD</creatorcontrib><creatorcontrib>Lee, Walter T., MD</creatorcontrib><title>Effectiveness of a postoperative disposition protocol for sleep apnea surgery</title><title>American journal of otolaryngology</title><addtitle>Am J Otolaryngol</addtitle><description>Abstract Purpose 1) Evaluate the effectiveness of a postoperative disposition protocol for upper airway surgery in patients with sleep apnea. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery versus surgical intensive care admission determined by preoperative screening criteria. Materials and methods A new preoperative protocol for sleep apnea surgery was instituted at the Durham Veterans Affairs Medical Center in 2008 to triage patients undergoing sleep apnea surgery to one of three postoperative dispositions: intensive care, routine ward bed, or discharge home. An Institutional Review Board approved retrospective chart review of patients undergoing sleep apnea surgery between May 2008 and January 2012 was performed. Postoperative complications and cost comparisons were assessed between each of the three postoperative disposition groups. Results 115 patients underwent sleep apnea surgery between July 2008 and January 2012. 11 patients were excluded leaving 104 patients in the final analysis. Median follow-up was 1.25 months. Overall complication rate was 12.5%. Eight complications occurred in the group triaged to intensive care, and 5 occurred in those triaged to lesser levels of postoperative care. All serious complications occurred during the immediate postoperative period. Based on only room charges, $125,275 was saved over the 3.6 years of this study. Conclusion A post operative disposition protocol can be effectively used to triage patients to less than intensive postoperative care. In institutions like the Durham VA, where sleep apnea patients were routinely triaged to intensive care, postoperative resources will be more efficiently utilized.</description><subject>Adult</subject><subject>Aged</subject><subject>Ambulatory Care - economics</subject><subject>Ambulatory Care - statistics & numerical data</subject><subject>Body mass index</subject><subject>Cardiovascular disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Cohort Studies</subject><subject>Coronary vessels</subject><subject>Cost control</subject><subject>Cost Savings</subject><subject>Cost-Benefit Analysis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart failure</subject><subject>Hospitalization - economics</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Incidence</subject><subject>Intensive care</subject><subject>Laryngoplasty - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Narcotics</subject><subject>Otolaryngology</subject><subject>Postoperative Care - standards</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Postoperative period</subject><subject>Preoperative Care - methods</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk factors</subject><subject>Severity of Illness Index</subject><subject>Sleep apnea</subject><subject>Sleep Apnea Syndromes - diagnosis</subject><subject>Sleep Apnea Syndromes - surgery</subject><subject>Sleep disorders</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Triage - methods</subject><subject>United States</subject><subject>Veterans</subject><issn>0196-0709</issn><issn>1532-818X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtrFTEUgIMo9rb6D0QG3HQz4zlJ5rURpFQrVFyo0F3ITU4k49zJmMwU7r83w60K3bgKnHzn9R3GXiFUCNi8HSp9GMISKg7IK8QKsH3CdlgLXnbY3T1lO8C-KaGF_oydpzQAgJCifs7OuBCCS-h37PO1c2QWf08TpVQEV-hiDmkJM0W9hQvrUw74xYepmGNuaMJYuBCLNBLNhZ4n0kVa4w-KxxfsmdNjopcP7wX7_uH629VNefvl46er97elkbJeSilc0-9NY1pBtW77DtC0VjgpQaOwRoLoNbTSadw3xjYoNXSty1_WcgAnLtjlqW4e6NdKaVEHnwyNo54orEmh6BD6BqHL6JtH6BDWOOXpMtVybGTfbJQ8USaGlCI5NUd_0PGoENSmWw3qpFttuhWiyrpz2uuH4uv-QPZv0h-_GXh3AijbuPcUVTKeJkPWx6xd2eD_1-FxATP6yRs9_qQjpX-7qMQVqK_bybeLY_bE2_pO_Aal-aeV</recordid><startdate>20130701</startdate><enddate>20130701</enddate><creator>Rocke, Daniel, MD, JD</creator><creator>Sharp, Scott, MD</creator><creator>Wiener, Dana, MD</creator><creator>Puscas, Liana, MD</creator><creator>Lee, Walter T., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7QR</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20130701</creationdate><title>Effectiveness of a postoperative disposition protocol for sleep apnea surgery</title><author>Rocke, Daniel, MD, JD ; Sharp, Scott, MD ; Wiener, Dana, MD ; Puscas, Liana, MD ; Lee, Walter T., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-43f69bc6c73e5a79801c7d3f440a13dc4039a074fa1b6cd614a087f13ddd200f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Ambulatory Care - economics</topic><topic>Ambulatory Care - statistics & numerical data</topic><topic>Body mass index</topic><topic>Cardiovascular disease</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Cohort Studies</topic><topic>Coronary vessels</topic><topic>Cost control</topic><topic>Cost Savings</topic><topic>Cost-Benefit Analysis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart failure</topic><topic>Hospitalization - economics</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Incidence</topic><topic>Intensive care</topic><topic>Laryngoplasty - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Narcotics</topic><topic>Otolaryngology</topic><topic>Postoperative Care - standards</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Postoperative period</topic><topic>Preoperative Care - methods</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk factors</topic><topic>Severity of Illness Index</topic><topic>Sleep apnea</topic><topic>Sleep Apnea Syndromes - diagnosis</topic><topic>Sleep Apnea Syndromes - surgery</topic><topic>Sleep disorders</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Triage - methods</topic><topic>United States</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rocke, Daniel, MD, JD</creatorcontrib><creatorcontrib>Sharp, Scott, MD</creatorcontrib><creatorcontrib>Wiener, Dana, MD</creatorcontrib><creatorcontrib>Puscas, Liana, MD</creatorcontrib><creatorcontrib>Lee, Walter T., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of otolaryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rocke, Daniel, MD, JD</au><au>Sharp, Scott, MD</au><au>Wiener, Dana, MD</au><au>Puscas, Liana, MD</au><au>Lee, Walter T., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of a postoperative disposition protocol for sleep apnea surgery</atitle><jtitle>American journal of otolaryngology</jtitle><addtitle>Am J Otolaryngol</addtitle><date>2013-07-01</date><risdate>2013</risdate><volume>34</volume><issue>4</issue><spage>273</spage><epage>277</epage><pages>273-277</pages><issn>0196-0709</issn><eissn>1532-818X</eissn><coden>AJOTDP</coden><abstract>Abstract Purpose 1) Evaluate the effectiveness of a postoperative disposition protocol for upper airway surgery in patients with sleep apnea. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery versus surgical intensive care admission determined by preoperative screening criteria. Materials and methods A new preoperative protocol for sleep apnea surgery was instituted at the Durham Veterans Affairs Medical Center in 2008 to triage patients undergoing sleep apnea surgery to one of three postoperative dispositions: intensive care, routine ward bed, or discharge home. An Institutional Review Board approved retrospective chart review of patients undergoing sleep apnea surgery between May 2008 and January 2012 was performed. Postoperative complications and cost comparisons were assessed between each of the three postoperative disposition groups. Results 115 patients underwent sleep apnea surgery between July 2008 and January 2012. 11 patients were excluded leaving 104 patients in the final analysis. Median follow-up was 1.25 months. Overall complication rate was 12.5%. Eight complications occurred in the group triaged to intensive care, and 5 occurred in those triaged to lesser levels of postoperative care. All serious complications occurred during the immediate postoperative period. Based on only room charges, $125,275 was saved over the 3.6 years of this study. Conclusion A post operative disposition protocol can be effectively used to triage patients to less than intensive postoperative care. In institutions like the Durham VA, where sleep apnea patients were routinely triaged to intensive care, postoperative resources will be more efficiently utilized.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23332409</pmid><doi>10.1016/j.amjoto.2012.11.017</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Aged Ambulatory Care - economics Ambulatory Care - statistics & numerical data Body mass index Cardiovascular disease Chronic obstructive pulmonary disease Cohort Studies Coronary vessels Cost control Cost Savings Cost-Benefit Analysis Female Follow-Up Studies Heart failure Hospitalization - economics Hospitalization - statistics & numerical data Hospitals Humans Hypertension Incidence Intensive care Laryngoplasty - methods Male Middle Aged Narcotics Otolaryngology Postoperative Care - standards Postoperative Complications - epidemiology Postoperative Complications - physiopathology Postoperative period Preoperative Care - methods Retrospective Studies Risk Assessment Risk factors Severity of Illness Index Sleep apnea Sleep Apnea Syndromes - diagnosis Sleep Apnea Syndromes - surgery Sleep disorders Surgery Treatment Outcome Triage - methods United States Veterans |
| title | Effectiveness of a postoperative disposition protocol for sleep apnea surgery |
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