Regional Anesthesia Cost Effectiveness


 

Reg Anesth 1997 May;22(3):260-266

Comparison of accuracy and cost of disposable, nonmechanical pumps used for epidural infusions.

Valente M, Aldrete JA

University of Michigan Medical School, Ann Arbor, USA.

BACKGROUND AND OBJECTIVES: Temporary epidural catheter pumps are used to infuse analgesics in patients with chronic intractable pain. Three brands of disposable, nonmechanical pumps adapted for epidural infusion were tested to determine their flow rate efficacy and their cost effectiveness. METHODS: Three pump models were tested: the Baxter (2C1075), Homepump (H100020), and SurgiPEACE (SP500-24). Manufacturers of each unit claim to provide a constant 2-mL/h flow rate. A standard setup was used to simulate both the insertion of the catheter into the epidural space and the environmental conditions consistent with patient ambulation. Reservoirs were filled with water and allowed to infuse into a collection receptacle, and flow rates were measured hourly. Four trials were performed with four separate units and flow rate measurements were averaged to determine a flow rate pattern over the entire infusion period. Data were graphed as the percentage of expected flow rate (% of 2 mL/h) versus infusion time (hours), the 90-110% range being defined as acceptable. RESULTS: All pumps initially infused at a rate above 110% for the first 3-6 hours, after which a steady decline in flow rate was observed. The Homepump produced a flow rate in the acceptable range for the greatest part of its infusion period (41%), followed by the SurgiPEACE (34%), and the Baxter unit (10.4%). The Baxter unit was also cumbersome to handle and therefore difficult to fill. The Homepump unit was easily handled but offered considerable resistance to filling, with partial loss of fluid. The SurgiPEACE unit was easy to handle and fill; however, in two of the units tested, an initial blockage was encountered, and manual patency of the connector and/or catheter had to be established. CONCLUSIONS: All three units deviated considerably from the claimed flow rate of 2-mL/h, both at the beginning and at the end of the infusion. Presumably, the decreasing flow rates are responsible for the diminishing pain relief often experienced by patients over the course of the infusion. The Homepump unit appeared to be the most cost-effective and the easiest to handle and maintained an acceptable infusion rate for the greatest percentage of the infusion period. The considerable cost benefit of using a nonmechanical disposable pump as opposed to a costly but more reliable computerized pump appears to warrant further product improvement and development.

 


 

 

Arthroscopy 1996 Aug;12(4):482-488

Local anesthesia in outpatient knee arthroscopy: a comparison of efficacy and cost.

Lintner S, Shawen S, Lohnes J, Levy A, Garrett W

Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.

This study was performed to compare the efficacy, cost-effectiveness, and safety of general, regional, and local anesthesia when performing outpatient knee arthroscopy. The study consisted of two portions. A retrospective review of 256 outpatient knee arthroscopies was performed. The types of anesthesia used were general endotracheal, regional (epidural or spinal), and local. Comparisons were made between operative procedure, anesthesia procedure time, need for supplemental anesthesia, recovery room time and cost, pharmaceutical cost, and complications. A prospective study consisted of 100 consecutive outpatient knee arthroscopies performed using local anesthesia. Data identical to the retrospective portion were obtained. Visual analog scales were used in a patient questionnaire completed at the first postoperative visit to assess patient satisfaction with local anesthesia. The retrospective data showed similar demographics and operative procedures performed in the three study groups. The difference between operative time and total anesthetic time for the local group was 35 minutes less than for regional, and 23 minutes less than for the general group. These differences were statistically significant (P < or = .05). Total pharmaceutical cost was significantly less for the local group (P < or = .05). Recovery room cost for the local anesthesia group averaged $134 compared with $450 for regional and $527 for general. This difference was significant (P < or = .05). There were 19 complications with general anesthesia, 16 with regional anesthesia, and 2 with local. There were two regional and two local cases that needed subsequent general anesthesia. The prospective data showed nearly identical time and cost data. The patient questionnaire showed nearly universal acceptance and satisfaction with the use of local anesthesia. The use of local anesthesia for outpatient knee arthroscopy is safe, effective, and well accepted. The use of local anesthesia was shown to save a minimum of $400 per case compared with the other anesthetic methods studied.


 

Med Trop (Mars) 1996;56(4):367-372

Cost effectiveness of local regional anesthesia in a remote area.

[Article in French]

Faisy C, Gueguen G, Lanteri-Minet M, Blatt A, Iloumbou J

Service d'Anesthesie-Reanimation, Hopital A. Sice Pointe Noire, Rpublique du Congo.

Loco-regional anesthesia techniques are considered as a simple and economic solution to problems posed by anesthesia in developing countries. However the cost benefits of some techniques are reduced by cardiovascular effects that affect the quantity and nature of peroperative vascular filling usually necessary during general anesthesia. The purpose of the present study was to ascertain the relative costs of these methods by comparing the quantity of crystalloid solution and blood administered during loco-regional anesthesias and general anesthesias in a general hospital center in Africa. In a retrospective cohort of 1050 consecutive patients operated on in the Surgery and Gynecology/Obstetrics Departments of the A. Sice Hospital in Pointe Noire (Congo), 495 included in a study comparing perimedullary anesthesia and general anesthesia. The total volume of solution and blood administered to the patients during the procedure was studied in function of the type of anesthesia and surgery performed. Results showed that the amount of crystalloid solution administered during peridural and spinal anesthesia tended to be higher. This difference was significant only for prostate surgery. Use of epidural anesthesia did not increase the quantity of fluid modified gelatin and blood transfused in this series. It was also observed that 55% of patients who underwent peridural anesthesia required further intravenous anesthesia as opposed to 18.8% of patients who underwent spinal anesthesia. These findings indicate that loco-regional anesthesia performed under standardized conditions does not significantly change the quantity and nature of preoperative filling usually necessary during general anesthesia. Thus these techniques can be considered as cost-effective in developing countries even though the long period necessary for practitioners to learn them results in a transient increase in cost. A prospective study by surgical groups with experience using loco-regional anesthesia is needed to confirm this study.


 

Am J Surg 1995 Aug;170(2):140-143

Are one-day admissions for carotid endarterectomy feasible?

Collier PE

Department of Surgery, Sewickley Valley Hospital, Pennsylvania, USA.

BACKGROUND: In 1990, a clinical pathway for streamlining the care of patients undergoing elective carotid endarterectomy was developed and tested at our institution. This consisted of extensive preoperative patient education in the surgeon's office, outpatient arteriography (now performed only on select patients), same-day admission, regional anesthesia when possible, selective use of the intensive care unit (ICU), and early discharge in the first postoperative day when feasible. PATIENTS AND METHODS: Between January 1, 1991 and June 30, 1994, 186 patients were entered into the protocol. Twenty-six percent of the patients were asymptomatic, while 74% had either transient symptoms or a prior stroke; 13% were operated on under general anesthesia. RESULTS: Three (1.6%) patients developed neurologic complications: 1 minor stroke, 1 transient ischemic attack, and 1 intracerebral hematoma; and 18 (10%) patients required the ICU postoperatively. On the first postoperative day, 157 patients were discharged. Average operative time was 48 minutes (range 39 to 61). Average length of stay (LOS) was 1.27 days. One death occurred on the 28th postoperative day from cardiac causes, and there were no hospital readmissions. Cost savings were over $3,000/patient when compared to the diagnosis-related group reimbursement. Because of the distribution of the data, statistical analysis was not feasible; however, several trends were clear. Neurologic complications, admission to the ICU, and increasing LOS all diminished the cost efficiency of carotid endarterectomy. Type of anesthesia and the use of a shunt or patching did not affect cost. Clearly, increasing the length of operation would also decrease cost efficiency. CONCLUSIONS: Adoption of the clinical pathway presented here is feasible in any institution. One-day admission for patients undergoing carotid endarterectomy has been shown to be safe, highly cost-effective, and results in more efficient use of scarce resources, such as the ICU.


 

Am J Surg 1995 May;169(5):512-515

Short-stay carotid endarterectomy is safe and cost-effective.

Kraiss LW, Kilberg L, Critch S, Johansen KJ

Department of Surgery, University of Washington, Seattle, USA.

BACKGROUND: Carotid endarterectomy (CEA) is conventionally performed following a contrast arteriogram, under general anesthesia, and with postoperative admission to an intensive care unit (ICU). We investigated whether any of these traditional adjuncts to CEA is necessary. PATIENTS AND METHODS: Eighteen consecutive patients had CEA performed according to a protocol of duplex scanning only, operation under regional anesthesia, and admission to the ICU only in cases of a proven need for services unique to the ICU (group I). Utilization of preoperative arteriography, admission to the ICU, postoperative complications, total hospital length of stay, and hospital charges were calculated for this group and results were compared with a group of 178 patients undergoing conventional CEA (arteriography, general anesthesia, routine ICU admission) during the same period (group II). RESULTS: In group I, 1 patient (6%) underwent preoperative arteriography and 4 patients (22%) were admitted to the ICU after CEA. Most group II patients (114 of 178, or 64%) underwent preoperative arteriography and virtually all (175 of 178, or 98%) were admitted to the ICU. Compared with group II, the average hospital length of stay for group I was significantly shorter (1.3 +/- 0.1 versus 3.1 +/- 0.3 days, P = 0.03) and hospital charges were significantly reduced ($5,861 +/- 229 versus $11,140 +/- 729, P = 0.02). CONCLUSIONS: This pilot study suggests that CEA can be safely performed without routine preoperative carotid arteriography; that routine ICU admission is unnecessary for the majority of cases; and that elimination of routine arteriography and ICU admission can reduce hospital charges for CEA by nearly one half.

 


 

Am J Sports Med 1995 Jan;23(1):50-53

Local anesthesia for knee arthroscopy. Efficacy and cost benefits.

Shapiro MS, Safran MR, Crockett H, Finerman GA

Department of Orthopaedic Surgery, University of California, Los Angeles 90024.

We performed a retrospective review of a series of knee arthroscopic procedures that were completed using local, general, or regional anesthesia to evaluate the efficacy of these anesthetic techniques. Operative time, complications or failures, procedures successfully performed, recovery room time and postoperative stay, and patient satisfaction were recorded. Local anesthesia with intravenous sedation compared favorably with the other techniques: operative time was not increased, a large variety of operative procedures were successfully completed, recovery time was significantly shortened, and patient satisfaction remained high. This technique offers several advantages over other types of anesthesia for knee arthroscopy, including improved cost effectiveness.

 


 

Am Surg 1989 Nov;55(11):656-659

Cost effectiveness of regional anesthesia in carotid endarterectomy.

Godin MS, Bell WH 3d, Schwedler M, Kerstein MD

Department of Otolaryngology, University of California at San Diego, La Jolla.

The purpose of this prospective study was to assess safety, efficacy, and hospital costs (excluding medications) and laboratory tests related to general (GA) and regional anesthesia (RA) for carotid endarterectomy (CEA). One hundred patients underwent CEA; 50 received GA and 50 received RA. Thirty-eight men (eight diabetic) and 12 women (two diabetic), with an average age of 62.4 (47 to 79) years comprised the GA group; 35 men (six diabetic) and 15 women (one diabetic), with an average age of 64.1 (51 to 74) years comprised the RA group. Twenty-one patients (17 men, 4 women) in the GA and 24 patients (19 men, 5 women) in the RA group had hypertension. Every patient had some stigmata of cardiac disease. Patients receiving GA for CEA spent an average of 1.2 days in the surgical Intensive Care Unit (ICU) and 6.1 days in a regular hospital bed, for an average cost of $4547. The patients who underwent CEA under RA had an average of 0.1 ICU days and 4.1 regular hospital days, for a cost of $2067. RA saved $2480 per patient and $124,000 in our study group, with no increase in mortality or morbidity rates (P less than 0.001). RA is superior to GA in cost-effectiveness for patients undergoing CEA.