Impact of perioperative hemodynamic optimization therapies in surgical patients: economic study and meta-analysis

Abstract

Background: Several studies suggest that hemodynamic optimization therapies can reduce complications, the length of hospital stay and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health system. Methods: A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients who underwent standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs (equipment depreciation, estate and management activities) were not included in the analysis. Results: A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR = 0.66; 95% CI = 0.58-0.74), renal (RR = 0.68; 95% CI = 0.54-0.87), and cardiovascular (RR = 0.87; 95% CI = 0.76-0.99) complications and a nonstatistically significant lower rate of respiratory complications (RR = 0.82; 95% CI = 0.67-1.02). There was no difference in mortality (RR = 1.02; 95% CI = 0.80-1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83-BRL ($90,161.38-USD) for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer days in the intensive care unit and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47-BRL ($371,173.27-USD) for every 1000 patients treated. Conclusions: Hemodynamic optimization therapy is cost-effective and would increase the efficiency of and decrease the burden of the Brazilian public health system.

Improving perioperative care in low-resource settings with goal-directed therapy: a narrative review

“…In fact, hemodynamic optimization therapy based on CO measurements is cost-effective and would increase efficiency and decrease the burden on the public health system. 39 Expert consensus recommends discussions with national/hospital decision-makers about cost-effectiveness, as the extra cost due to hemodynamic monitoring when implementing a perioperative GDT strategy is counterbalanced by the reduction in postoperative complications and hospital length of stay in high-risk surgeries.…”

Perioperative organ dysfunction: a burden to be countered

“…EMAPO, Multicenter study of perioperative evaluation for non-cardiac surgeries in Brazil (EMAPO); 14 Brasis: Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil. 15 All images were created with BioRender.com by Ricardo Esper Treml using Academic License Terms. …”