The Financial Impact of Increasing Surgical Complexity: Contribution of Sugammadex as Safer Choice for Neuromuscular Blockade Reversal in an Ambulatory Surgical Center

Introduction: Several surgical procedures may have efficiency gains with the ambulatory methodology. Patient comorbidities control is key for successful procedures. Anesthetic drugs and neuromuscular blockade reversal strongly contribute to patient safety and satisfaction, allowing evolution to more complex procedures. Purpose: This study evaluated the financial impact on hospital annual income, when transitioning some surgical procedures from inpatient to ambulatory surgical program, with anesthesiology department assentment. Methods: A risk-adjustment method, based on a logistic regression model, calibrated with approximately 1.15 million episodes from Spanish and Portuguese hospitals was used. A list of procedures performed in Centro Hospitalar do Porto was subject to classification with the label ('Yes', 'No' or 'Maybe') regarding the possibility for ambulatory surgery, relying on sugammadex safety. Results: A total of 153 procedures were classified as 'Yes' or 'maybe' (n=16,944 inpatient episodes), in 2014. 73.4% of these episodes were already performed in ambulatory, but it was expected to reach 85.5%. Assuming a consumption of at least 1 inpatient day for each potentially ambulatory episode, an overconsumption of at least 2,044 inpatient days in 2014 was forecasted. The potential financing gain in 2014 would be 4.59 Million Euros. Discussion: To safely ambulatorize and improve revenue, not only patient selection must be optimized, but also safe routines and choices of correct short acting drugs (propofol, rocuronium), and definitive drug reversal policies (sugammadex), must be implemented. Conclusions: To ambulatorize some inpatient surgical procedures increased both case-mix values. These increased complexity values have a direct positive impact on the hospital income.