Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
Can J Anaesth. 2023 Aug;70(8):1340-1349. doi: 10.1007/s12630-023-02519-x. Epub 2023 Jul 10.
Patients with impaired functional capacity who undergo major surgery are at increased risk of postoperative morbidity including complications and increased length of stay. These outcomes have been associated with increased hospital and health system costs. We aimed to assess whether common preoperative risk indices are associated with postoperative cost.
We conducted a health economic analysis focused on the subset of Measurement of Exercise Tolerance before Surgery (METS) study participants in Ontario, Canada. Participants were scheduled for major elective noncardiac surgery and underwent several preoperative assessments of cardiac risk, including physicians' subjective assessment, Duke Activity Status Index (DASI) questionnaire, peak oxygen consumption, and N-terminal pro-B-type natriuretic peptide concentration. Using linked health administrative data, postoperative costs were calculated for both one year and in-hospital. Using multiple regression models, we tested for association between the preoperative measures of cardiac risk and postoperative costs.
Our study included 487 patients (mean [standard deviation] age 68 [11] yr and 47.0% female) who underwent noncardiac surgery between 13 June 2013 and 8 March 2016. Overall, the median [interquartile range] cost incurred within one year postoperatively was CAD 27,587 [13,902-32,590], of which CAD 12,928 [10,253-12,810] were incurred in-hospital and CAD 14,497 [10,917-15,017] were incurred by 30 days. None of the four preoperative measures of cardiac risk assessment were associated with costs incurred in hospital or at one year postoperatively. This lack of strong association persisted in sensitivity analyses considering type of surgical procedure, burden of preoperative cost, and when costs were categorized as quantiles.
In patients undergoing major noncardiac surgery, common measures of functional capacity are not consistently associated with total postoperative cost. Until further data exist that differ from this analysis, clinicians and health care funders should not assume that preoperative measures of cardiac risk are associated with annual health care or hospital costs for such surgeries.
功能能力受损的患者在接受大手术后，其术后发病率（包括并发症和住院时间延长）增加。这些结果与医院和卫生系统成本增加有关。我们旨在评估常见的术前风险指标是否与术后成本相关。
我们进行了一项健康经济学分析，重点关注加拿大安大略省测量手术前运动耐量（METS）研究参与者的亚组。参与者计划接受主要的择期非心脏手术，并接受了几项心脏风险的术前评估，包括医生的主观评估、杜克活动状态指数（DASI）问卷、峰值耗氧量和 N 末端 pro-B 型利钠肽浓度。利用链接的健康管理数据，计算了术后一年和住院期间的术后成本。使用多元回归模型，我们测试了术前心脏风险指标与术后成本之间的关联。
我们的研究包括 487 名患者（平均[标准差]年龄 68[11]岁，47.0%为女性），他们于 2013 年 6 月 13 日至 2016 年 3 月 8 日之间接受了非心脏手术。总体而言，术后一年内的中位[四分位数间距]成本为 CAD27587[13902-32590]，其中 CAD12928[10253-12810]发生在住院期间，CAD14497[10917-15017]发生在术后 30 天内。心脏风险评估的四项术前措施均与住院期间或术后一年内的成本无关。在考虑手术类型、术前成本负担以及按成本分类时，这种缺乏强烈关联的情况在敏感性分析中仍然存在。
在接受大非心脏手术的患者中，常见的功能能力测量方法与总术后成本并不一致。在出现与该分析不同的数据之前，临床医生和卫生保健资金提供者不应认为术前心脏风险测量与这些手术的年度医疗保健或住院费用相关。
