Use of Perioperative Advanced Practice Providers to Reduce Cost and Readmission in the Postoperative Hepatopancreatobiliary Population: Results of a Simulation Study

Abstract

Background: Postoperative healthcare utilization and readmissions are common among the hepatopancreatobiliary (HPB) population. We evaluated the surgical volume required to sustain advanced practice providers (APPs) in the perioperative setting for cost reduction. Study Design: Using decision analysis modeling, we evaluated costs of employing dedicated perioperative APP Navigators compared with no APPs Navigators. Simulated subjects could: 1) present to an emergency department (ED), with or without readmission, 2) present for direct readmission, 3) require additional office visits, or 4) no additional care. We informed our model using the most current available published data and performed sensitivity analyses to evaluate thresholds under which dedicated perioperative APP Navigators are beneficial. Results: Subjects within the APP Navigators cohort accumulated $1,270 and a readmission rate of 6.9%, compared with $2,170 and 13.5% with No APP Navigators, yielding a cost-savings of $905 and 48% relative reduction in readmission. Based on these estimated cost-savings and national salary ranges, a perioperative APPs become financially self-sustaining with 113 to 139 annual HPB cases, equating to 2 to 3 HPB cases weekly. Sensitivity analyses revealed that perioperative APP Navigators were no longer cost-saving when direct readmission rates exceeded 8.9% (base case 3.7%). Conclusions: We show that readmissions are reduced by nearly 50% with an associated cost-savings of $900 when employing dedicated perioperative APPs. This position becomes financially self-sufficient with an annual HPB case load of 113 to 139 cases. High-volume HPB centers could benefit from post-discharge APP Navigators to optimize outcomes, minimize high-value resource utilization, and ultimately save costs.