Effects of a low-cost protocol on outcome and cost in a group practice setting

To investigate, in a group practice setting, the effects of combining information about drug costs with adoption of a voluntary low-cost protocol.

Prospective before-and-after intervention comparison study.

Private practice anesthesiology group (certified registered nurse-anesthetists and anesthesiologists) of a large midwestern for-profit hospital.

Clinical outcome and anesthesia-related drug cost were examined for coronary artery bypass grafts (CABG), laparoscopic cholecystectomy (LC), and lumbar laminectomy (LL). There were no restrictions on the use of any drug if warranted by the patient's condition. 135 consecutive prospective (P) cases performed by the anesthesiology group after the intervention were retrospectively matched by surgery type and surgeon to cases done 9 months prior to the protocol to form the retrospective control group (R) resulting in a total sample of 270 subjects. Significant cost reductions were seen in LC-(57%), LL-(42%), and CABG-(37%). The largest cost reductions were opioids (78%), induction drugs (50%), and muscle relaxants (41%). There were no differences in pain, nausea, or hypertension scores between the P and R groups, but there were minor differences in recovery room, oxygen therapy, and dismissal times between the R and P groups of LC and LL patients. There were no differences in anesthetic outcome for CABG patients between the P and R groups. A follow-up survey completed 4 months after the study demonstrated that muscle relaxant costs and fresh gas flow rates and costs had returned to preintervention levels, while opioid and induction drug savings were maintained.

A private practice anesthesia group that followed a voluntary protocol could significantly reduce drug cost with little change in clinical outcome. However, the savings may not be completely maintained after the monitoring period.