Manecke Gerard R, Asemota Angela, Michard Frederic
Crit Care. 2014 Oct 11;18(5):566. doi: 10.1186/s13054-014-0566-1.
Pay-for-performance programs and economic constraints call for solutions to improve the quality of health care without increasing costs. Many studies have shown decreased morbidity in major surgery when perioperative goal directed fluid therapy (GDFT) is used. We assessed the clinical and economic burden of postsurgical complications in the University HealthSystem Consortium (UHC) in order to predict potential savings with GDFT.
Data from adults who had a major surgical procedure in 2011 were screened in the UHC database. Thirteen post-surgical complications were tabulated. In-hospital mortality, hospital length of stay and costs from patients with and without complications were compared. The risk ratios reported by the most recent meta-analysis were used to estimate the potential reduction in post-surgical morbidity with GDFT. Potential cost-savings were calculated from the actual and anticipated morbidity rates.
A total of 75,140 patients met the search criteria, and 8,421 patients developed one or more post-surgical complications (morbidity rate 11.2%). In patients with and without complications, in-hospital mortality was 12.4% and 1.4% (P <0.001), mean hospital length of stay was 20.5 ± 20.1 days and 8.1 ± 7.1 days (P <0.001) and mean direct costs were $47,284 ± 49,170 and $17,408 ± 15,612 (P < 0.001), respectively. With GDFT, morbidity rate was projected to decrease to 8.0 - 9.3%, yielding gross costs savings of $43 M - $73 M for the study population or $569 - $970 per patient.
Postsurgical complications have a dramatic impact (+172%) on costs. Potential costs savings resulting from GDFT are substantial. Perioperative GDFT may be recommended not only to improve quality of care but also to decrease costs.
绩效薪酬计划和经济限制要求在不增加成本的情况下提高医疗质量的解决方案。许多研究表明，围手术期目标导向液体治疗（GDFT）用于大手术时，发病率会降低。我们评估了大学卫生系统联盟（UHC）中术后并发症的临床和经济负担，以预测GDFT可能带来的节省。
在UHC数据库中筛选2011年接受大手术的成年人的数据。列出了13种术后并发症。比较了有并发症和无并发症患者的住院死亡率、住院时间和费用。使用最新荟萃分析报告的风险比来估计GDFT术后发病率的潜在降低。根据实际和预期发病率计算潜在成本节省。
共有75140名患者符合搜索标准，8421名患者发生了一种或多种术后并发症（发病率11.2%）。有并发症和无并发症患者的住院死亡率分别为12.4%和1.4%（P<0.001），平均住院时间分别为20.5±20.1天和8.1±7.1天（P<0.001），平均直接费用分别为47284±49170美元和17408±15612美元（P<0.001）。使用GDFT，发病率预计将降至8.0 - 9.3%，为研究人群节省4300万至7300万美元的总成本，或为每位患者节省569至970美元。
术后并发症对成本有巨大影响（增加172%）。GDFT带来的潜在成本节省巨大。围手术期GDFT不仅可能被推荐用于提高护理质量，还能降低成本。
