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Preoperative spirometry and laparotomy: blowing away dollars

L A De Nino1, V A Lawrence, E C Averyt

  • 1South Texas Veterans Healthcare System, Audie L. Murphy Division: Geriatric Research, Education and Clinical Center, San Antonio, USA.

Chest
|June 1, 1997
PubMed
Summary

Reducing routine pulmonary function tests (PFTs) before abdominal surgery can save millions. Studies show PFTs don't predict complications and their reduced use won't harm patients.

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Area of Science:

  • Health Economics
  • Surgical Outcomes Research
  • Pulmonary Medicine

Background:

  • Routine preoperative pulmonary function tests (PFTs) before elective abdominal surgery are increasingly questioned for their predictive value.
  • Evidence suggests PFTs are overutilized and do not accurately predict individual risk of postoperative pulmonary complications.

Purpose of the Study:

  • To estimate the potential cost savings associated with reducing the use of preoperative PFTs.
  • To evaluate the economic impact of current PFT utilization in elective abdominal surgery.

Main Methods:

  • Economic evaluation analyzing real costs and third-party payer reimbursements for PFTs.
  • Utilized data from university-affiliated public and Veterans Affairs hospitals.
  • Incorporated published literature and local data on abdominal operations and PFT frequency.

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Main Results:

  • Estimated annual national real costs for preoperative PFTs range from $25 million to $45 million.
  • Potential annual national cost savings from reduced PFT use are estimated between $7.9 million and $21.4 million.
  • National reimbursement expenditures could be reduced by $29 million to $111 million annually, with Medicare savings approaching $8 million to $20 million.

Conclusions:

  • Reducing the utilization of PFTs before elective abdominal surgery can lead to significant financial savings.
  • Current evidence suggests that decreasing PFT use will not negatively impact patient outcomes.
  • The findings support a more judicious approach to preoperative PFTs in this patient population.