Continuous Intraoperative Hemodynamic Monitoring Decreases In-hospital Costs.

Abstract

Study design: Retrospective comparative cohort.

Objective: To determine if the use of Predictive Hemodynamic Monitoring (PHM) leads to cost savaings for the institution.

Summary of background data: A recent study showed that the use of PHM during posterior spine fusions decreases episodes of intra-operative hypotension, complications and length of stay.

Methods: Adults undergoing elective multi-level instrumented posterior thoracolumbar fusion with PHM (N=47) were identified and propensity-matched to those in whom it was not (Non-PHM, N=70). Demographic and surgical data, intra-op and post-op hemodynamic and fluid management data and complications were collected. Cost data were stratified into Surgery (admission to recovery room discharge), Post-operative (recovery room to hospital discharge) and 90-days after discharge.

Results: Propensity matching produced 41 patients each in the PHM and Non-PHM groups. The PHM group had a shorter duration of intra-op hypotension (6.6 min vs. 13.33 min, P=0.044); and shorter duration of intra-op hypertension (2.4 min vs. 6.7 min, P=0.029) compared to the Non-PHM group. Volume of colloids, fluids and blood products transfused intra- and post-operatively were similar.There was a lower but not statistically significant number of complications per patient in the PHM compared to the Non-PHM group (P=0.053) and a statistically significant shorter length of stay (4.5 vs. 7.0, P=0.011). Surgery costs were similar between the two groups ($41,482 vs. $42,264, P=0.853). Post-operative costs were lower in the PHM ($2,757) compared to the Non-PHM group ($5,339, P=0.001), driven mostly by Room & Board ($1,639 vs. $3,597, P<0.001). Pharmacy ($248 vs. $429, P=0.007), Labs ($108 vs. $178, P=0.020) and Therapy ($448 vs. $877, P=0.003). Costs in the 90 days after discharge were similar between the two groups ($593 vs. $438, P=0.574).

Conclusions: The use of PHM decreases intra-operative hemodynamic instability. This may be associated with a lower incidence of complications, decreased length of stay and a potential cost savings of $2,500 per case.