Logo image
Back
Length of Stay and Cost of Care Differences Between Postoperative Patients Who Board in PACU and Those That Proceed Directly to Inpatient Bed
Journal article   Peer reviewed

Length of Stay and Cost of Care Differences Between Postoperative Patients Who Board in PACU and Those That Proceed Directly to Inpatient Bed

David F Nelson, Carla Palomino, Marc C Torjman, Gavyn Ooi and Michael S Green
Perioperative care and operating room management, v 37, 100434
Sep 2024
DOI: https://doi.org/10.1016/j.pcorm.2024.100434

Abstract

boarding costs length of stay perioperative post-anesthesia care unit
Bottlenecks in PACU throughput are frequently encountered challenges that OR managers must face. This study seeks to examine the impact of extended PACU stay (e.g. boarding) on both total hospital length of stay and overall cost of care. A total of 4,740 patients were studied having same-day admit surgeries for seven procedure types including: arthroplasty total knee, arthroplasty total hip, fusion spine transforaminal interbody lumbar, revision arthroplasty total knee, revision arthroplasty total hip, posterior cervical fusion, and anterior cervical fusion. 4,471 were identified as non-PACU boarders and 269 as PACU boarders (>6 hours in PACU). Included in the analysis were demographics, date of admission, surgical procedure, PACU and hospital length of stay (HLOS), hospital direct costs, case mix index (CMI), and ASA status. The median (IQR) PACU times in minutes were 57.00 (80) and 488.00 (453.50) minutes for PACU non-boarders and boarders (p<0.001). HLOS was significantly (p<0.001) more elevated in PACU Boarders compared to PACU Non-boarders: median (IQR) 2.00 (2.00) and 2.00 (3.00), (mean HLOS 3.16±2.83 vs 2.60±2.71 days). Median direct costs were ≈14.36% higher (p=0.008) for the PACU boarders compared to Non-boarders. Direct costs were also not significantly different when using a 4-hour criteria for PACU boarders (14.39% higher median direct costs, p=0.004). PACU boarding (>4 hours) is associated with a statistically significant increased length of stay as well as direct costs compared with non-boarders across a variety of elective orthopedic and spine procedures. Thus, when frequent PACU boarding occurs, OR managers should consider the potential impact to patient care and hospital margins.

Metrics

69 Record Views
2 citations in Web of Science
2 citations in Scopus

Details

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Collaboration types
Domestic collaboration
Web of Science research areas
Anesthesiology
Surgery
Logo image