Nardi-Hiebl Stefan, Wallenborn Jan, Schniertshauer Martin, Koch Tilo, Gruebl Tobias, Torossian Alexander
Department of Anesthesiology and Intensive Care Therapy, Philipps-University of Marburg, University Hospital, Marburg, Germany.
Department of Anesthesiology and Intensive Care Medicine, HELIOS Klinikum Aue, Aue, Germany.
BMC Anesthesiol. 2025 Jul 17;25(1):349. doi: 10.1186/s12871-025-03240-6.
Perioperative warming is essential in preventing hypothermia during surgery, a condition linked to adverse outcomes like increased infection rates, impaired coagulation, and extended hospital stays. Despite the availability of various active warming methods, such as forced-air warming (FAW) and electric warming systems, their implementation and associated costs vary significantly across hospitals, impacting resource allocation and patient care.
This study used a prospective, multicenter, activity-based costing approach across four German hospitals with diverse capacities. The activity-based costing model identified and measured staff time, material use, and direct costs linked to perioperative warming processes in a sample of 225 surgical patients. Warming processes were assessed across stages, including pre-warming, intraoperative warming, and post-anesthesia care.
Findings show significant variability in the time and cost associated with perioperative warming across institutions. The average total cost per patient between all sites ranged from EUR 3.52 to EUR 49.26, with an overall mean cost of EUR 12.29 per patient. Staff time also varied, with nurses contributing most of the required time dedicated to warming activities. At all sites, FAW was the available method during surgery, but inconsistent practices and reliance on supplemental strategies lead to considerable cost variations.
This study illustrates potential operational and financial challenges of perioperative warming, revealing significant variability in costs and resource requirements across hospitals, influenced by institutional infrastructure, workflow efficiency and case mix. The findings also emphasize the importance of optimizing workflows and adopting best practices tailored to resource constraints. Future research should address these gaps by exploring cost-effective warming protocols, balancing efficiency with care quality, and refining workflows to enhance patient outcomes.
围手术期保暖对于预防手术期间的体温过低至关重要，体温过低与诸如感染率增加、凝血功能受损和住院时间延长等不良后果相关。尽管有多种主动保暖方法可供使用，如强制空气保暖（FAW）和电暖系统，但它们在各医院的实施情况和相关成本差异很大，影响资源分配和患者护理。
本研究采用前瞻性、多中心、基于活动的成本核算方法，对德国四家不同规模的医院进行研究。基于活动的成本核算模型识别并测量了225例手术患者样本中与围手术期保暖过程相关的员工时间、材料使用和直接成本。对包括预热、术中保暖和麻醉后护理在内的各个阶段的保暖过程进行了评估。
研究结果表明，各机构围手术期保暖的时间和成本存在显著差异。所有站点每位患者的平均总成本在3.52欧元至49.26欧元之间，每位患者的总体平均成本为12.29欧元。员工时间也有所不同，护士贡献了大部分用于保暖活动的所需时间。在所有站点，FAW是手术期间可用的方法，但做法不一致以及对补充策略的依赖导致了相当大的成本差异。
本研究说明了围手术期保暖在运营和财务方面的潜在挑战，揭示了各医院在成本和资源需求方面存在显著差异，这受到机构基础设施、工作流程效率和病例组合的影响。研究结果还强调了优化工作流程和采用针对资源限制量身定制的最佳实践的重要性。未来的研究应通过探索具有成本效益的保暖方案、在效率与护理质量之间取得平衡以及优化工作流程以改善患者结局来填补这些空白。
