A cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients

Abstract

Perioperative increase of oxygen delivery in high risk surgical patients not only improves survival, but also provides an actual and relative cost saving. This may have important implications for the management of these patients and the funding of intensive care.

A Cost-Effectiveness Analysis of Postoperative Goal-Directed Therapy for High-Risk Surgical Patients*

“…First, we deliberately choose the postoperative period to avoid preoperative admissions. Guest et al (38) studied the impact of GDT in the entire perioperative period and showed potential cost savings of up to 31% (£6,916.90 vs £10,008.20) could be achieved. Although these absolute and relative cost savings are higher than those in our study, their findings neglect the logistic difficulties associated with pre-and intraoperative application of GDT.…”

“…Most of these studies did not take long-term outcomes into account or were applied in the pre-or intraoperative period (38)(39)(40), where logistic problems could arise and hinder successful implementation of this strategy. Our study circumvents most of the shortcomings found in previous analysis.…”

Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis

“…Shoemaker [1] concluded that average hospital charges and patient expenditures were reduced for pa-tients receiving pre-op, but did not undertake a formal cost-effectiveness analysis. Guest et al [4] provided a detailed analysis of the cost of resources associated with pre-operative optimisation and standard patient management pre-operatively, intra-operatively, post-operatively and employed in treating complications. They concluded that the median cost per patient and per survivor was lower for the group receiving pre-op [4].…”

“…Guest et al [4] provided a detailed analysis of the cost of resources associated with pre-operative optimisation and standard patient management pre-operatively, intra-operatively, post-operatively and employed in treating complications. They concluded that the median cost per patient and per survivor was lower for the group receiving pre-op [4]. However, the use of medians rather than means reduces the impact of any extreme values on the results, and where data are likely to be highly skewed (as costs typically are) the use of medians will not facilitate an estimate of the total cost impact across a sample of patients [14] In addition, the use of the number of survivors, at 28 days post-surgery, as the measure of effectiveness limits the analysis through the implicit assumption that life expectancy for survivors is identical between the groups.…”

“…There is also evidence that the use of pre-op results in reduced hospital costs [1,2] and that it constitutes a cost-effective method of managing high-risk surgery [4]. However, these results have yet to have a major influence on surgical management.…”