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Evidence-based Practice and Quality Improvement

Perioperative hemodynamic goal directed therapy: potential cost-savings with implementation

1AP6-8

Simon, T. -P.; Michard, F.; Marx, G.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 23-23
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Background: Many studies have demonstrated the ability of perioperative Hemodynamic Goal Directed Therapy(pGDT) to decrease post-operative morbidity in patients undergoing medium-to-high risk surgery(1). Because of post-operative morbidity reduction,As a result pGDT may actually be a cost-saving strategy. Our goal was to provide an estimation of potential costsavings based on recent literature.

Materials and Methods: The largest and most recent meta-analysis1 on pGDT was used to estimate what could be the reduction of post-operative morbidity if pGDT was to be adopted. Costs related to the treatment of patients developing at least 1 (1+) post-operative complications were obtained from two recent US2 and Swiss3 publications. Potential cost-savings related to the adoption of pGDT were calculated according to the actual morbidity rate, assuming 0%pGDT use so far, and 100% compliance rate after implementation.

Results: The 2011 meta-analysis1 of 29 RCTs (4,805 patients) showed that pGDT is associated with a reduction in the rate of patients developing 1+ post-operative complications with odd ratios ranging between 0.35 and 0.55. Importantly, these odd ratios were not related to the morbidity rates. In the US publication2, extra-costs for treating patients with 1+ complication were $17,949. In the Swiss (CH) publication3, they were $34,446.

Table
Table:
[Cost reduction with pGDT]

Conclusion: Depending on the pre-implementation morbidity rate, the degree of pGDT-induced morbidity reduction and the country, cost-savings ranged between $808 and $13,434 per patient. This large variability suggests that local/hospital estimations are desirable before starting pGDT implementation. These tailored evaluations would also allow more precise cost-saving estimations by taking into account the actual and expected pGDT compliance rates.

References:

1. Hamilton MA et al: A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 2011; 112:1392-1402;
2. Boltz et al: Synergistic implications of multiple postoperative outcomes. Am J Med Qual 2012; in press;
3. Vonlanthen R et al: The impact of complications on costs of major surgical procedures. A cost-analysis of 1200 patients. Ann Surg 2011; 254:907-13
© 2013 European Society of Anaesthesiology