Is Surgical Location a Predictor of High Healthcare Utilization?

Objectives: To determine if there is a difference in high healthcare utilization (HHU) between surgeries performed at a hospital or ASC and to determine if demographics, medical history, and perioperative factors contributed to HHU.

Methods: This is a retrospective cohort study of subjects from the Assessing Healthcare Utilization and Feasibility of Urethral Catheter Self-discontinuation (FLOTUS) study. Adult women who underwent outpatient urogynecologic surgery for a benign indication at an academic institution from 8/1/2021 to 11/30/22 were included. Subjects with active malignancy, surgeries not requiring voiding trials, upper motor neuron disease, and surgery outside the pelvis were excluded. Demographic information and perioperative data including healthcare utilization and complications occurring within 30 days of surgery was collected. HHU was defined as office visits, calls, or messages falling into the 4th quartile and/or any visits to the emergency department (ED). Appropriate statistical analyses were performed using STATA.

Results: 378 subjects met inclusion criteria: 90 were HHU and 288 were not. There was no difference in HHU for surgery performed at a hospital versus ASC (25 vs 22%, p=0.52). HHU participants were less likely to be obese (19 vs 32%, p=0.02) or pass their POD0 VT (33 vs 71%, p< 0.001) but more likely to undergo TVH (47 vs 31%, p=0.01) and have a surgical complication (23 vs 1%, p< 0.001). However, patients undergoing surgery at an ASC were more likely to be younger, healthier, and less likely to undergo hysterectomy or colpopexy. On regression analysis, obesity was associated with a decreased risk of HHU (aOR 0.29, 95% CI 0.09 – 0.96, p=0.04) while a surgical complication was associated with increased risk of HHU (aOR 38.1, 95% CI 4.10 – 354.7, p=0.001). Surgery at a hospital was not associated with an increased risk of HHU (aOR 1.31, 95% CI 0.49 – 3.53, p=0.27).

Conclusions: Surgery at a hospital was not associated with increased HHU compared to ASC. Obesity was protective of HHU while having a surgical complication increased the risk of HHU.