Postoperative Care: In Hospital or at Home?

Abstract

This study was carried out, first, to determine the feasibility of postoperative home care for three elective operations and, second, to explore the feasibility of introducing postoperative home care as a more economical alternative for the following surgical procedures: herniorrhaphy, vaginal hysterectomy, and vein stripping. Clinical, environmental, operative, and socioeconomic criteria were applied to 487 outpatients of which 44 pairs were selected and matched by age, sex, diagnosis, environmental, and socioeconomic characteristics. Each member of a pair was randomly assigned to either hospital care or home care. The place of postoperative care was disclosed only after the operation. After three to five hours in the recovery room, the hospital care patient was transferred to the general surgical wards and the home care patient was transferred by ambulance to his home. There were two minor complications in the home care group and three in the hospital care group. The duration of convalescence was significantly shorter for home care patients with post–hernia repair and with hysterectomy. Economic analysis showed that from the hospital viewpoint, the average cost for both herniorrhaphy and hysterectomy home care patients is one–fourth of the average cost of hospital care. The home care alternative also provides for other savings which are described in the study.

A meta‐analysis of “hospital in the home”

“…Of the 34 studies in which any cost data were presented, 32 concluded that HITH care was cheaper 12 . ‐ 16 , 23 , 24 , 27 ‐ 29 , 33 ‐ 36 , 40 ‐ 43 , 46 , 48 , 49 , 51 , 53 , 55 , 59 ‐ 64 , 69 , 70 The other two studies concluded that hospital care was cheaper 40 , 71 .…”

“…Of the 34 studies in which any cost data were presented, 32 concluded that HITH care was cheaper. [12][13][14][15][16]23,24,[27][28][29][33][34][35][36][40][41][42][43]46,48,49,51,53,55,[59][60][61][62][63][64]69,70 The other two studies concluded that hospital care was cheaper. 40,71 Overall, the cost for HITH care was 73.5% of the average for the control groups.…”

“…We included studies from the community, 21-24 emergency departments (EDs), [28][29][30][31][32][33][36][37][38][39][40][41][42][44][45][46][47][48]55,59,70 hospitalisations in departments other than EDs, [11][12][13][14][15][16][17][18][19][20][25][26][27]34,35,43,[48][49][50][51][52][53][54][56][57][58][60][61][62][63][64]…”

“…7,8 Most HITH services are nurse based, but they may include doctors and allied health professionals. 9,10 Some focus on specialties (eg, surgical specialties, [11][12][13][14][15][16][17][18][19][20] medical specialties, [21][22][23][24][25][26][27][28][29][30][31][32][33] rehabilitation medicine, 34,35 geriatrics, 36,37 psychiatry, [38][39][40][41][42] infectious diseases, 43,44 respiratory diseases [45][46][47][48][49][50][51][52][53][54][55] or orthopaedics 56 ), diagnostic groups (eg, h...…”

Gestión logística en la prestación de servicios de hospitalización domiciliaria en el Valle del Cauca: caracterización y diagnóstico

“…A pesar del auge de estas instituciones, la revisión de la literatura muestra que, a la fecha, no se ha desarrollado ninguna investigación que permita caracterizar los retos y requerimientos logísticos que enfrentan los administradores de servicios de HHC. Solo un trabajo presenta la implementación de estos servicios en el departamento del Valle del Cauca desde una perspectiva médica (Echeverri, Manzano, Gomez, Quintero y Cobo, 1972). Estos hechos evidencian la necesidad de caracterizar e identificar la gestión logística en la prestación de servicios de HHC en el contexto nacional y regional, para contribuir en la disminución de la brecha entre el estado del arte y la realidad de la prestación de los servicios en dicho contexto.…”