Continuous Intraoperative Hemodynamic Monitoring Decreases In-Hospital Costs
Leah Y Carreon1, Steven D Glassman1, Desiree Chappell2
1Norton Leatherman Spine Center, Louisville, KY.
Study Design:
Retrospective comparative cohort.
Objective:
To determine whether the use of predictive hemodynamic monitoring (PHM) leads to cost savings for the institution.
Summary Of Background Data:
A recent study showed that the use of PHM during posterior spine fusions decreases episodes of intraoperative hypotension, complications, and length of stay.
Methods:
Adults undergoing elective multi-level instrumented posterior thoracolumbar fusion with PHM (N=47) were identified and propensity-matched to those in whom it was not (Non-PHM, N=70). Demographic and surgical data, intraop and postop hemodynamic and fluid management data and complications were collected. Cost data were stratified into Surgery (admission to recovery room discharge), Postoperative (recovery room to hospital discharge) and 90 days after discharge.
Results:
Propensity matching produced 41 patients each in the PHM and Non-PHM groups. The PHM group had a shorter duration of intraop hypotension (6.6 vs. 13.33 min, P =0.044); and shorter duration of intraop hypertension (2.4 vs. 6.7 min, P =0.029) compared with the Non-PHM group. Volume of colloids, fluids, and blood products transfused intraoperatively and postoperatively were similar.There was a lower but not statistically significant number of complications per patient in the PHM compared with the Non-PHM group ( P =0.053) and a statistically significant shorter length of stay (4.5 vs. 7.0, P =0.011). Surgery costs were similar between the two groups ($41,482 vs. $42,264, P =0.853). Postoperative costs were lower in the PHM ($2757) compared with the Non-PHM group ($5339, P =0.001), driven mostly by Room & Board ($1639 vs. $3597, P <0.001). Pharmacy ($248 vs. $429, P =0.007), Labs ($108 vs. $178, P =0.020), and Therapy ($448 vs. $877, P =0.003). Costs in the 90 days after discharge were similar between the two groups ($593 vs. $438, P =0.574).
Conclusions:
The use of PHM decreases intraoperative hemodynamic instability. This may be associated with a lower incidence of complications, decreased length of stay, and a potential cost savings of $2500 per case.
