284. The cost effectiveness of an ICU outreach program on adverse events after spine surgery

Abstract

BACKGROUND CONTEXT The Spinal Surgery AdVerse Events System (SAVES) was developed in 2008 with the intention of assessing the frequency and impact of postoperative adverse events (AEs) following spinal surgery. Over the study period this system identified a number of “minor” adverse events (Grade 1 and 2) occurring frequently; electrolyte imbalance, medication related issues, postoperative ileus and nausea. In daily practice. these may often be dismissed as trivial. However, growing evidence shows the accumulation of minor AEs may have a larger than anticipated consequence. In 2012 an ICU outreach program was developed where high dependency postoperative spine patients were reviewed daily by an intensive care physician. PURPOSE The purpose of this study was to examine the efficacy and cost-effectiveness of the introduction an ICU outreach program on adverse events in postoperative high dependency spine patients. STUDY DESIGN/SETTING This prospective cohort study took place at a single quaternary spine referral center. PATIENT SAMPLE All surgical patients admitted to a quaternary spine center for the outlined study periods. OUTCOME MEASURES The frequency of postoperative AEs was recorded during each period, as identified by the SAVES framework. METHODS Data was prospectively collected during the 4-year period before (2008-2012) and after (2012-2016) the introduction of the ICU outreach program. Previous research has determined the cost of AEs which was applied to the data set. RESULTS Over the study period the mean number of patients admitted per year was 984 (912-1090). The introduction of the ICU outreach team lead to a dramatic decrease in the number of AEs reported during the postoperative period. The percentage of patients with electrolyte imbalance decreased by 35% from 46% to 30%. Medication-related events decreased by 70% from 40% to 12%, ileus/constipation 46% from 26% to 14%, nausea by 64% from 22% to 8%, cardiac complications by 55% from 18% to 8%, pulmonary by 65% from 17% to 6% and delirium/psychiatric by 62.5% from 12% to 4.5% (P-values CONCLUSIONS The introduction of an ICU outreach program to review postoperative high dependency spine patients reduces the incidence of minor adverse events and can lead to substantial cost savings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.