Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial

Khanna, Ashish K.; Jungquist, Carla R.; Buhre, W.; Soto, Roy G.; Piazza, Fabio Di; Saager, Leif

doi:10.1007/s12325-021-01779-7

Cited by 14 publications

(8 citation statements)

References 31 publications

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“…A recent study modeling the costs of continuous monitoring reported a combined pulse oximeter capnography unit to cost $4800 and a disposable pulse oximeter probe and capnography line to cost $8.50 and $14.50, respectively. 61 Telemetry to a central station with around-the-clock human monitoring has substantial costs. Furthermore, using condition-specific monitoring for a surveillance application is expensive and less effective for detecting general condition deterioration early (eg, cardiotelemetry in patients who do not meet American Heart Association criteria).…”

Section: Universal Continuous Monitoring Is Both Affordable and Assoc...mentioning

confidence: 99%

“…Depending on the business model used, estimates to install wireless pulse oximetry hardware range from a $0 out-of-pocket capital cost to $7000 per bed. 61 Sensor costs per patient also vary depending on the type, disposability, and patient length of stay. A recent study modeling the costs of continuous monitoring reported a combined pulse oximeter capnography unit to cost $4800 and a disposable pulse oximeter probe and capnography line to cost $8.50 and $14.50, respectively.…”

Section: Pro Position: Universal Continuous Respiratory Monitoring Of...mentioning

confidence: 99%

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Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

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McGrath,

Ochs Kinney

et al. 2024

Anesthesia &Amp; Analgesia

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In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual’s risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a “surveillance model” can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions.

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Section: Universal Continuous Monitoring Is Both Affordable and Assoc...mentioning

confidence: 99%

Section: Pro Position: Universal Continuous Respiratory Monitoring Of...mentioning

confidence: 99%

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Blike,

McGrath,

Ochs Kinney

et al. 2024

Anesthesia &Amp; Analgesia

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“…Fortunately, most episodes of respiratory depression are ‘self-limited’, and do not lead to immediate life-threatening events (e.g., respiratory arrest). However, surgical patients who experience seemingly benign, self-limited episodes of respiratory depression have been found to have increased hospital costs compared to patients who did not have postoperative respiratory depression [8 ▪▪ ,27 ▪ ]. In addition, self-limited episodes of respiratory depression in the postanesthesia recovery unit (PACU) have been associated with increased rates of postoperative pulmonary complications [28] including severe opioid toxicity requiring naloxone administration on wards [29,30].…”

Section: Obstructive Sleep Apnea and Self-limited Postoperative Respi...mentioning

confidence: 99%

Perioperative considerations for adult patients with obstructive sleep apnea

Weingarten

Šprung

2022

Current Opinion in Anaesthesiology

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Purpose of reviewObstructive sleep apnea (OSA) is a common, but often undiagnosed, sleep breathing disorder affecting approximately a third of adult surgical patients. OSA patients have increased sensitivity to anesthetic agents, sedatives, and opioid analgesics.Recent findingsNewer technologies (e.g., bedside capnography) have demonstrated that OSA patients have repetitive apneic spells, beginning in the immediate postoperative period and peaking in frequency during the first postoperative night. Compared to patients without OSA, OSA patients have double the risk for postoperative pulmonary as well as other complications, and OSA has been linked to critical postoperative respiratory events leading to anoxic brain injury or death. Patients with OSA who have respiratory depression during anesthesia recovery have been found to be high-risk for subsequent pulmonary complications. Gabapentinoids have been linked to respiratory depression in these patients.SummarySurgical patients should be screened for OSA and patients with OSA should continue using positive airway pressure devices postoperatively. Use of shorter acting and less sedating agents and opioid sparing anesthetic techniques should be encouraged. In particular, OSA patients exhibiting signs of respiratory depression in postanesthesia recovery unit should receive enhancer respiratory monitoring following discharge to wards.

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“…Capnography, in this context may be especially beneficial for patients on supplemental oxygen who may maintain adequate oxygenation despite hypoventilation [25]. Cost-effectiveness modeling data for continuous monitoring for postoperative hospital floor patients seems favorable in that a mere 2–3% reduction in OIRD episodes has provided a good enough return on investment to ‘break-even’ on the cost of continuous oximetry and capnography monitoring [26 ▪▪ ]. TJC states that hospitals should monitor patients at higher risk for opioid-related adverse outcomes (TJC PC.01.02.07 EP 6) and that appropriate equipment should be available to monitor patients at high risk for opioid-related adverse outcomes (TJC LD.04.03.13 EP 7) [27].…”

Section: Relevance Of Abuse In the Perioperative Periodmentioning

confidence: 99%

Opioid abuse and perioperative care: a new medical disease

Henshaw

Turner

Khanna

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThis review article aims to describe the perioperative clinical implications of opioid use or opioid use disorder (OUD) and to provide recommendations related to analgesia, anesthesia, and postoperative care for patients with this 'new medical disease'. Recent findingsEvidence suggest that 1 in 4 surgical patients will be using opioids preoperatively. Management of these patients, or those with OUD, can be challenging given their opioid tolerance, hyperalgesia, decreased pain tolerance, and increased pain sensitivity. Therefore, an individualized plan that considers how to manage OUD treatment medications, the risk of relapse, multimodal analgesia, and postoperative monitoring requirements is highly important. Fortunately, recent publications provide both insight and guidance on these topics. Postoperatively, persistent opioid utilization appears higher in patients currently using opioids and even for those with a prior history. Although numerous other adverse outcomes are also associated with opioid use or abuse, some may be modifiable with cessation. SummaryA coordinated, evidence-based, multidisciplinary team approach is critical when caring for patients with OUD to ensure safety, provide adequate analgesia, and reduce the risk of relapse. Enhanced postoperative monitoring, multimodal analgesia, and a plan for preoperative opioid management may help to modify the risks of adverse postoperative outcomes.

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Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial

Cited by 14 publications

References 31 publications

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Perioperative considerations for adult patients with obstructive sleep apnea

Opioid abuse and perioperative care: a new medical disease

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