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Perioperative Surgical Home Principles Applied to the Ambulatory Setting

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Manual of Practice Management for Ambulatory Surgery Centers

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Abstract

The Perioperative Surgical Home (PSH) is a patient-centered, multi-disciplinary care model aimed at improving patient outcomes, enhancing the overall patient experience, optimizing efficiency, and reducing costs. These considerations are well suited for the fast-paced setting of an Ambulatory Surgery Center. Preoperative interventions intended to optimize patient comorbidities and facilitate appropriate patient selection, intraoperative anesthetic approaches geared towards rapid recovery, and post-operative multimodal analgesic and nausea and vomiting (PONV) management, are a few highlights of this program. From an operational standpoint, processes that improve Operating Room throughput are also essential. Standardizing the delivery of care through the development of protocols, care team collaboration, and active patient engagement are strategies to achieve the goals of the PSH.

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References

  1. Friend TH, Paula A, Klemm J, Rosa M, Levine W. Improving operating room efficiency via reduction and standardization of video-assisted thoracoscopic surgery instrumentation. J Med Syst. 2018;42(7):116.

    Article  Google Scholar 

  2. Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am. 2015;97(17):1386–97.

    Article  Google Scholar 

  3. Kawaguchi M, Ida M, Naito Y. The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program. J Anesth. 2017;31(3):319–24.

    Article  Google Scholar 

  4. Moyer R, Ikert K, Long K, Marsh J. The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. JBJS Rev. 2017;5(12):e2.

    Article  Google Scholar 

  5. Caccialanza R, Klersy C, Cereda E, Cameletti B, Bonoldi A, Bonardi C, et al. Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients. CMAJ. 2010;182(17):1843–9.

    Article  Google Scholar 

  6. Myles PS, Iacono GA, Hunt JO, Fletcher H, Morris J, McIlroy D, et al. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers. Anesthesiology. 2002;97(4):842–7.

    Article  Google Scholar 

  7. Shi Y, Warner DO. Surgery as a teachable moment for smoking cessation. Anesthesiology. 2010;112(1):102–7.

    Article  Google Scholar 

  8. Kash BA, Zhang Y, Cline KM, Menser T, Miller TR. The perioperative surgical home (PSH): a comprehensive review of US and non-US studies shows predominantly positive quality and cost outcomes. Milbank Q. 2014;92(4):796–821.

    Article  Google Scholar 

  9. Zaugg M, Tagliente T, Lucchinetti E, Jacobs E, Krol M, Bodian C, et al. Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery. Anesthesiology. 1999;91(6):1674–86.

    Article  CAS  Google Scholar 

  10. White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F, et al. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg. 2007;104(6):1380–96, table of contents.

    Article  Google Scholar 

  11. Phan DL, Ahn K, Rinehart JB, Calderon MD, Wu WD, Schwarzkopf R. Joint arthroplasty Perioperative Surgical Home: impact of patient characteristics on postoperative outcomes. World J Orthop. 2016;7(6):376–82.

    Article  Google Scholar 

  12. Pędziwiatr M, Kisialeuski M, Wierdak M, Stanek M, Natkaniec M, Matłok M, Major P, Małczak P, Budzyński A. Early implementation of Enhanced Recovery After Surgery (ERAS®) protocol–compliance improves outcomes: a prospective cohort study. Int J Surg. 2015;21:75–81.

    Article  Google Scholar 

  13. Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999;87(6):1346.

    Google Scholar 

  14. Eisenach JC. Preventing chronic pain after surgery: who, how, and when? Reg Anesth Pain Med. 2006;31(1):1–3.

    PubMed  Google Scholar 

  15. Carroll IR, Angst MS, Clark JD. Management of perioperative pain in patients chronically consuming opioids. Reg Anesth Pain Med. 2004;29(6):576–91.

    Article  Google Scholar 

  16. Büttner B, Mansur A, Hinz J, Erlenwein J, Bauer M, Bergmann I. Combination of general anesthesia and peripheral nerve block with low-dose ropivacaine reduces postoperative pain for several days after outpatient arthroscopy: a randomized controlled clinical trial. Medicine. 2017;96(6):e6046.

    Article  Google Scholar 

  17. Dahl V, Raeder J. Regional anaesthesia in ambulatory surgery. Curr Opin Anaesthesiol. 2003;16(5):471–6.

    Article  Google Scholar 

  18. Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg. 2007;104(5):1265–9.

    Article  Google Scholar 

  19. Machi AT, Ilfeld BM. Continuous peripheral nerve blocks in the ambulatory setting: an update of the published evidence. Curr Opin Anaesthesiol. 2015;28(6):648–55.

    Article  CAS  Google Scholar 

  20. Iwuchukwu C, Wright D, Sofine A, Schwarzkopf R. Can a total knee arthroplasty perioperative surgical home close the gap between primary and revision TKA outcomes? Am J Orthop (Belle Mead NJ). 2016;45(7):E458–E64.

    Google Scholar 

  21. Gupta A, Kaur S, Khetarpal R, Kaur H. Evaluation of spinal and epidural anaesthesia for day care surgery in lower limb and inguinoscrotal region. J Anaesthesiol Clin Pharmacol. 2011;27(1):62–6.

    PubMed  PubMed Central  Google Scholar 

  22. Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology. 2002;97(2):315–9.

    Article  Google Scholar 

  23. Joshi GP, Twersky RS. Fast tracking in ambulatory surgery. Ambul Surg. 2000;8(4):185–90.

    Article  CAS  Google Scholar 

  24. Qiu C, Rinehart J, Nguyen VT, Cannesson M, Morkos A, LaPlace D, et al. An ambulatory surgery perioperative surgical home in Kaiser permanente settings: practice and outcomes. Anesth Analg. 2017;124(3):768–74.

    Article  Google Scholar 

  25. Watkins AC, White PF. Fast-tracking after ambulatory surgery. J Perianesth Nurs. 2001;16(6):379–87.

    Article  CAS  Google Scholar 

  26. White PF, Eng M. Fast-track anesthetic techniques for ambulatory surgery. Curr Opin Anaesthesiol. 2007;20(6):545–57.

    Article  Google Scholar 

  27. Jirasiritham S, Tantivitayatan K, Jirasiritham S. Propofol-based fast-track for ambulatory surgery. J Med Assoc Thail. 2004;87(6):656–9.

    Google Scholar 

  28. White PF, Rawal S, Nguyen J, Watkins A. PACU fast-tracking: an alternative to “bypassing” the PACU for facilitating the recovery process after ambulatory surgery. J Perianesth Nurs. 2003;18(4):247–53.

    Article  Google Scholar 

  29. Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60(3):289–334.

    Article  CAS  Google Scholar 

  30. Coloma M, Chiu JW, White PF, Armbruster SC. The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg. 2001;92(2):352–7.

    Article  CAS  Google Scholar 

  31. Hwang WJ, Moon YE, Cho SJ, Lee J. The effect of a continuous infusion of low-dose esmolol on the requirement for remifentanil during laparoscopic gynecologic surgery. J Clin Anesth. 2013;25(1):36–41.

    Article  CAS  Google Scholar 

  32. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102(6):1884–98.

    Article  Google Scholar 

  33. Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: a simple yet complex problem. Anesth Essays Res. 2016;10(3):388–96.

    Article  Google Scholar 

  34. Ronco GL. Sugammadex: the right option for the efficiency of the operating room? A methodology for cost/benefit analysis in comparison to the routine choice for reversal. Value Health. 2015;18(7):A732.

    Article  Google Scholar 

  35. Insinga RP, Joyal C, Goyette A, Galarneau A. A discrete event simulation model of clinical and operating room efficiency outcomes of sugammadex versus neostigmine for neuromuscular block reversal in Canada. BMC Anesthesiol. 2016;16(1):114.

    Article  Google Scholar 

  36. Rotondi AJ, Brindis C, Cantees KK, DeRiso BM, Ilkin HM, Palmer JS, et al. Benchmarking the perioperative process. I. Patient routing systems: a method for continual improvement of patient flow and resource utilization. J Clin Anesth. 1997;9(2):159–69.

    Article  CAS  Google Scholar 

  37. Dexter F, Macario A. Decrease in case duration required to complete an additional case during regularly scheduled hours in an operating room suite: a computer simulation study. Anesth Analg. 1999;88(1):72–6.

    CAS  PubMed  Google Scholar 

  38. Vetter TR, Goeddel LA, Boudreaux AM, Hunt TR, Jones KA, Pittet JF. The Perioperative Surgical Home: how can it make the case so everyone wins? BMC Anesthesiol. 2013;13:6.

    Article  Google Scholar 

  39. Sandberg WS, Daily B, Egan M, Stahl JE, Goldman JM, Wiklund RA, et al. Deliberate perioperative systems design improves operating room throughput. Anesthesiology. 2005;103(2):406–18.

    Article  Google Scholar 

  40. Vetter TR, Barman J, Hunter JM Jr, Jones KA, Pittet JF. The effect of implementation of preoperative and postoperative care elements of a perioperative surgical home model on outcomes in patients undergoing hip arthroplasty or knee arthroplasty. Anesth Analg. 2017;124(5):1450–8.

    Article  CAS  Google Scholar 

  41. Pasero C, Belden J. Evidence-based perianesthesia care: accelerated postoperative recovery programs. J Perianesth Nurs. 2006;21(3):168–76.

    Article  Google Scholar 

  42. Rana MV, Desai R, Tran L, Davis D. Perioperative pain control in the ambulatory setting. Curr Pain Headache Rep. 2016;20(3):18.

    Article  Google Scholar 

  43. Pędziwiatr M, Wierdak M, Nowakowski M, Pisarska M, Stanek M, Kisielewski M, Matłok M, Major P, Kłęk S, Budzyński A. Cost minimization analysis of laparoscopic surgery for colorectal cancer within the enhanced recovery after surgery (ERAS) protocol: a single-centre, case-matched study. Wideochir Inne Tech Maloinwazyjne. 2016;11(1):14–21.

    PubMed  PubMed Central  Google Scholar 

  44. Alem N, Rinehart J, Lee B, Merrill D, Sobhanie S, Ahn K, et al. A case management report: a collaborative perioperative surgical home paradigm and the reduction of total joint arthroplasty readmissions. Perioper Med (Lond). 2016;5:27.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Timothy J. Del Rosario & Jarrett Heard

  2. The Ohio State University Wexner Medical Center, Eye and Ear Institute Outpatient Surgery Center, Jameson Crane Sports Medicine Institute, Department of Anesthesiology, Columbus, OH, USA

    Michael Guertin

  3. Department of Anesthesiology, University of Minnesota Medical Center, Minneapolis, MN, USA

    David S. Beebe & Kumar G. Belani

Authors
  1. Timothy J. Del Rosario
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  2. Jarrett Heard
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  3. Michael Guertin
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  4. David S. Beebe
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  5. Kumar G. Belani
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Corresponding author

Correspondence to Michael Guertin .

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Editors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, PA, USA

    Niraja Rajan

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Del Rosario, T.J., Heard, J., Guertin, M., Beebe, D.S., Belani, K.G. (2020). Perioperative Surgical Home Principles Applied to the Ambulatory Setting. In: Rajan, N. (eds) Manual of Practice Management for Ambulatory Surgery Centers. Springer, Cham. https://doi.org/10.1007/978-3-030-19171-9_11

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  • DOI: https://doi.org/10.1007/978-3-030-19171-9_11

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  • Online ISBN: 978-3-030-19171-9

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