Postoperative nausea and vomiting prophylaxis from an economic point of view

Patients rank postoperative nausea and vomiting (PONV) in the top five most undesirable outcomes of surgery. Thirty percent of all surgical patients experience PONV. We conducted an economic study to determine the financial implications of providing surgical patients with PONV prophylaxis to increase patient satisfaction and minimize postoperative complications. Our main objective was to develop an economic model of PONV prophylaxis. We retrospectively reviewed all surgical cases who received care at our institution from June 2005 to June 2007 in which the surgical patient was billed for treatment of nausea and vomiting while in the hospital. The PONV risk factors for these patients were assessed as well as the revenue stream associated with those patients who returned to the hospital within 5 days with nausea and vomiting as their chief complaint. Of the total number of medical charts reviewed (56,532), 28 (1.57%) of 1783 patients who were billed for PONV while in the hospital returned to the hospital with PONV. The total billable charges for PONV for these returning patients were $83,674; the total reimbursements were $25,816 yielding a 31% reimbursement rate. The total hospital expenses were $24,123 yielding a net hospital profit of $1693 for treating these 28 patients. The average hospital cost and charge per antiemetic drug dose was $0.304 and $3.66, respectively. Using these figures, we determined that our hospital's net profit increases linearly with increased PONV prophylaxis administration. Our economic analysis shows that PONV prophylaxis is economically beneficial for the hospital when weighed against the expenses generated by treating patients returning to the hospital with PONV.