Abstract
BackgroundPreventable postsurgical complications are increasingly recognized as a major clinical and economic burden. A recent meta-analysis showed a 17–29 % decrease in postoperative morbidity with goal-directed fluid therapy. Our objective was to estimate the potential economic impact of perioperative goal-directed fluid therapy.MethodsWe studied 204,680 adult patients from 541 US hospitals who had a major non-cardiac surgical procedure between January 2011 and June 2013. Hospital costs (including 30-day readmission costs) in patients with and without complications were extracted from the Premier Inc. research database, and potential cost-savings associated with a 17–29 % decrease in postoperative morbidity were estimated.ResultsA total of 76,807 patients developed one or more postsurgical complications (morbidity rate 37.5 %). In patients with and without complications, hospital costs were US$27,607 ± 32,788 and US$15,783 ± 12,282 (p < 0.0001), respectively. Morbidity rate was anticipated to decrease to 26.6–31.1 % with goal-directed fluid therapy, yielding potential gross cost-savings of US$153–263 million for the study period, US$61–105 million per year, or US$754–1286 per patient. Potential savings per patient were highly variable from one surgical procedure to the other, ranging from US$354–604 for femur and hip-fracture repair to US$3515–5996 for esophagectomies. When taking into account the volume of procedures, the total potential savings per year were the most significant (US$32–55 million) for colectomies.ConclusionsPostsurgical complications occurred in more than one third of our study population and had a dramatic impact on hospital costs. With goal-directed fluid therapy, potential cost-savings per patient were US$754–1286. The highest cost-savings per year were observed for colectomies. These projections should help hospitals estimate the return on investment when considering the implementation of goal-directed fluid therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-015-0021-0) contains supplementary material, which is available to authorized users.
Highlights
Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden
We believe that our study provides a more accurate estimation of potential savings associated with the implementation of Goal-directed fluid therapy (GDFT) at a national level
Assuming average cardiac output-monitoringrelated costs of US$300 per patient (US$250 for disposable sensor + US$48 for the amortization of a US$15,000 monitor used two times a week over 3 years), our findings suggest that for each dollar spent to implement GDFT, hospitals should save in return between US$2.5 and US$4
Summary
Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden. Our objective was to estimate the potential economic impact of perioperative goal-directed fluid therapy. Especially in patients with co-morbidities, complications are not exceptions (Ghaferi et al 2009) and have adverse effects on long-term quality of life and survival (Khuri et al 2005; Brown et al 2014; Artinyan et al 2015). They are Perioperative fluid management is a key determinant of postoperative outcome.
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