Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature

Graff, Valérie; Gabutti, Luca; Treglia, Giorgio; Pascale, Mariarosa; Anselmi, Luciano; Cafarotti, Stefano; Regina, Davide La; Mongelli, Francesco; Saporito, Andrea

doi:10.1016/j.bjane.2021.09.012

Cited by 12 publications

(11 citation statements)

References 40 publications

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“…Discussion | We found a considerable cost savings resulting from discontinuation of medications for diabetes after metabolic surgery, which only represented prescription activity for 1 year following metabolic surgery and did not account for potential cumulative savings as a result of longterm diabetes remission or downstream cost benefits associated with optimizing diabetes management. [3][4][5] It is important to note that payment measures were derived for patients enrolled in BCBS PPO commercial plans and may differ with other payment types. Moreover, extrapolating results assumes that the larger population of patients undergoing bariatric surgery have a similar distribution of prescription use for diabetes.…”

Section: Supplemental Contentmentioning

confidence: 99%

“…For example, the use of regional anesthesia in ambulatory surgery is associated with a reduction in recovery time and overall hospital costs. 4 Transitional pain clinics are another example of an anesthesiology-led multidisciplinary initiative to safely wean patients from opioids after surgery and reduce chronic postsurgical pain. 5…”

Section: Supplemental Contentmentioning

confidence: 99%

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Financial Impact of Metabolic Surgery on Prescription Diabetes Medications in Michigan

Varban

Hassett²,

Yost³

et al. 2023

JAMA Surg

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Section: Supplemental Contentmentioning

confidence: 99%

Section: Supplemental Contentmentioning

confidence: 99%

Financial Impact of Metabolic Surgery on Prescription Diabetes Medications in Michigan

Varban

Hassett²,

Yost³

et al. 2023

JAMA Surg

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show abstract

“…Neuromodulation in pain management has grown in popularity and has become the current ‘buzzword’ in the acute pain field; yet, it is not a new concept. The International Neuromodulation Society1 defines neuromodulation as ‘the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.’ In clinical practice, therapeutic neuromodulation has been the mainstay of acute pain management in the form of regional anesthesia (ie, local anesthetics),2 whereas using electricity with peripheral nerve stimulation (PNS) has commonly been used for chronic pain management for decades. Hence, the only caveat for acute settings is that neuromodulation approaches have primarily focused on pharmacological means (ie, local anesthetic) while overlooking the electrical modularity (ie, PNS) until recently.…”

Section: Introductionmentioning

confidence: 99%

Role of neuromodulation in acute pain settings

Tsui

Gupta

2023

Reg Anesth Pain Med

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Peripheral nerve stimulation (PNS), a type of neuromodulatory technique, is increasingly used to treat chronic pain syndromes. PNS has also recently gained popularity as a viable adjunct analgesic modality in acute pain settings, where the practice primarily relies on using boluses or infusion of local anesthetics for nerve blockade, followed by stimulation to extend the analgesia. There is some early promise in PNS for perioperative analgesic control, but considerable obstacles must be addressed before it can be implemented into standard practice. In this daring discourse, we explore the possibilities and constraints of using the PNS paradigm in acute pain.

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“…The implementation of best practice pathways include avoiding unnecessary preoperative investigations, blood management programs, choice of anesthetic modality, delirium reduction pathways, pain management, and postoperative monitoring. For example, the use of regional anesthesia in ambulatory surgery is associated with a reduction in recovery time and overall hospital costs . Transitional pain clinics are another example of an anesthesiology-led multidisciplinary initiative to safely wean patients from opioids after surgery and reduce chronic postsurgical pain …”

mentioning

confidence: 99%

Anesthesiologists Are Integral to Value-Based Surgical Care Reform

Flexman

2023

JAMA Surg

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To the Editor We read the Viewpoint by Pitt and Dossett with great interest. 1 We appreciate the authors' thoughtful recommendations to deimplement low-value care by reducing care components that are costly and of limited benefit. These recommendations are a worthwhile first step to contain costs and optimize use of strained health care resources exacerbated by the COVID-19 pandemic.With some surprise, we noted that the authors did not discuss anesthesia-related care as part of their strategic recommendations, despite the inclusion of other health care professionals. Our specialties are intertwined, as virtually all surgery involves anesthesia and vice versa. Notably, anesthetic care is not mentioned in the Viewpoint, although many of the same strategies recommended for surgeons could easily apply to anesthesiologists. For example, anesthesiology societies and journals can (and do) promote deimplementation of low-value care through guidelines and clinical practice recommendations. Porter's original concept of value-based care noted that "the proper unit for measuring value should encompass all services or activities that jointly determine success in meeting a set of patient needs," 2 which indicates the need to include all stakeholders.In collaboration with other perioperative health care professionals, anesthesiologists have multiple opportunities to contribute our unique skill set to high-value surgical care, including preoperative assessment and optimization, intraoperative management, pain management, and postoperative surveillance. As noted by the authors, 1 opportunities to increase value occur throughout the surgical trajectory and beyond the operating room, and this applies to anesthetic care as well. Areas where anesthesiologists have made substantial contributions to value-based surgical care include efficient operating room management, avoiding day-of-surgery cancellations through optimization and preassessment, and segmentation of patients into low-vs high-variance procedures to optimize process, safety, and efficiency. 3 The implementation of best practice pathways include avoiding unnecessary preoperative investigations, blood management programs, choice of anesthetic modality, delirium reduction pathways, pain management, and postoperative monitoring. For example, the use of regional anesthesia in ambulatory surgery is associated with a reduction in recovery time and overall hospital costs. 4 Transitional pain clinics are another example of an anesthesiology-led multidisciplinary initiative to safely wean patients from opioids after surgery and reduce chronic postsurgical pain. 5 We thank the authors for their informative review and agree that improving the value of surgical care for patients is needed and will no doubt be challenging and complex. One thing is for certain-it will require a team effort.

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Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature

Cited by 12 publications

References 40 publications

Financial Impact of Metabolic Surgery on Prescription Diabetes Medications in Michigan

Financial Impact of Metabolic Surgery on Prescription Diabetes Medications in Michigan

Role of neuromodulation in acute pain settings

Anesthesiologists Are Integral to Value-Based Surgical Care Reform

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