title: Optimizing Value of Colon Surgery in Michigan.
abstract: To assess the value of bundling perioperative care measures in colon surgery.
  
  
  
  Surgical site infections (SSI) in colectomy are associated with increased morbidity and cost. Perioperative care bundling has been designed to improve processes of care surrounding colectomy operations.
  
  
  
  Retrospective cohort study performed by the Michigan Surgical Quality Collaborative (MSQC) of patients who underwent elective colon surgery from 2012 to 2015. We identified 3,387 patients in the MSQC database who underwent colon surgery. Of these cases, 332 had associated episodic cost data.
  
  
  
  High compliance (3-6 bundle elements) and low compliance (0-2 bundle elements) had a risk-adjusted SSI rate of 8.2% (95% confidence interval, CI, 7.2-9.2%) and 16.0% (95% CI, 12.9-19.1%), respectively (P < 0.01). When compared with low compliance, the high compliance group had an absolute risk reduction of 3.6% (P < 0.01), 2.9% (P < 0.01) and 1.3% (P < 0.01) for SSI rates in superficial space, deep space, and organ space, respectively. Low compliance had an average episodic cost of $20,046 (95% CI, $17,281-$22,812) whereas high compliance had an episodic cost of $15,272 (95% CI, $14,354-$16,192). This showed a $4,774 (95% CI, $1,859-$7,688) and 23.8% cost reduction (P < 0.01). Facility base payments decreased 14.8% ($13,444; $11,458), professional payments decreased 43.9% ($5,180; $2,906), and other payments decreased 36.2% ($1,422; $908).
  
  
  
  A colectomy perioperative care bundle in Michigan is associated with improved value of surgical care. We will expand efforts to implement perioperative care bundles in Michigan to improve outcomes and reduce costs.
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Jaffe
authors.forename: Arjun P
authors.initials: AP
authors.lastname: Meka
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Semaan
authors.forename: Uchenna
authors.initials: U
authors.lastname: Okoro
authors.forename: Charles
authors.initials: C
authors.lastname: Hwang
authors.forename: Joseph
authors.initials: J
authors.lastname: Papin
authors.forename: Andrew
authors.initials: A
authors.lastname: Mullard
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001831:Body Temperature; D003082:Colectomy; D017046:Cost Savings; D019983:Guideline Adherence; D006801:Humans; D008824:Michigan; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D019990:Perioperative Care / Q000191:economics* / Q000379:methods* / Q000592:standards; D058996:Quality Improvement; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose