PIN67 BUDGET IMPACT ANALYSIS OF THE IMPLEMENTATION OF A PRESURGICAL WARMING PROTOCOL TO EFFECTIVELY MANAGE SURGICAL PATIENT NORMOTHERMIA

Abstract

Perform a budget impact analysis from a hospital perspective and estimate the cost savings achieved by adding a presurgical warming protocol to intra-operative warming, using a forced-air warming system to prevent inadvertent perioperative hypothermia (IPH). The one-year time horizon budget impact model is based on a new static decision-tree, modified from a model published by NICE in 2008. Based on IPH rate, the model allows a comparison of different patient temperature management strategies with associated material and adverse consequences costs. The current analysis uses IPH rates measured in a German hospital when implementing active pre-warming plus intra-operative warming versus intra-operative warming only. Adverse consequences of IPH, according to the NICE guidance, are grouped in surgical site infections (SSI), morbid cardiac events (MCE) and other complications, including the need of blood transfusions. The cost of the adverse consequences is monetized via increased length-of-stay (LOS). The model accounts for minor, intermediate and major surgery and four different age groups following German DRG-data to evaluate the relative risk for SSI and MCE. The costs of a bed-day on a surgical ward are derived from WHO estimates. The hypothermia rate from a retrospective study including 7786 patients having a surgery duration of at least 30 minutes under general anesthesia showed an IPH decrease from 12.4% to 5.1% with the introduction of active pre-warming in addition to intra-operative warming. For a hypothetical hospital conducting 1,000 surgical procedures per year (48% minor, 30% intermediate and 22% major), the implementation of pre-warming could result in total annual cost savings of 192,220€, corresponding to 60% direct costs decrease, 300 less hypothermia events and 342 days reduction in attributable LOS. The implementation of pre-warming is a cost saving intervention and should be recommended for effective management of patient normothermia.