The association between intraoperative low driving pressure ventilation and perioperative healthcare-associated costs: A retrospective multicenter cohort study - 11/09/24
, Elena Ahrens a, b, 1 , Aiman Suleiman c, d , Dario von Wedel a, b , Tim M. Tartler a, b, Maíra I. Rudolph d, e , Simone Redaelli a, b, f , Peter Santer a, b , Ricardo Munoz-Acuna a, b , Abeer Santarisi d, g , Harold N. Calderon h , Michael E. Kiyatkin d , Lena Novack a, b , Daniel Talmor a , Matthias Eikermann d, i , Maximilian S. Schaefer a, b, j, ⁎ Abstract |
Study objective |
A low dynamic driving pressure during mechanical ventilation for general anesthesia has been associated with a lower risk of postoperative respiratory complications (PRC), a key driver of healthcare costs. It is, however, unclear whether maintaining low driving pressure is clinically relevant to measure and contain costs. We hypothesized that a lower dynamic driving pressure is associated with lower costs.
Design |
Multicenter retrospective cohort study.
Setting |
Two academic healthcare networks in New York and Massachusetts, USA.
Patients |
46,715 adult surgical patients undergoing general anesthesia for non-ambulatory (inpatient and same-day admission) surgery between 2016 and 2021.
Interventions |
The primary exposure was the median intraoperative dynamic driving pressure.
Measurements |
The primary outcome was direct perioperative healthcare-associated costs, which were matched with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP–NIS) to report absolute differences in total costs in United States Dollars (US$). We assessed effect modification by patients' baseline risk of PRC (score for prediction of postoperative respiratory complications [SPORC] ≥ 7) and effect mediation by rates of PRC (including post-extubation saturation < 90%, re-intubation or non-invasive ventilation within 7 days) and other major complications.
Main results |
The median intraoperative dynamic driving pressure was 17.2cmH2O (IQR 14.0–21.3cmH2O). In adjusted analyses, every 5cmH2O reduction in dynamic driving pressure was associated with a decrease of −0.7% in direct perioperative healthcare-associated costs (95%CI −1.3 to −0.1%; p = 0.020). When a dynamic driving pressure below 15cmH2O was maintained, -US$340 lower total perioperative healthcare-associated costs were observed (95%CI −US$546 to −US$132; p = 0.001). This association was limited to patients at high baseline risk of PRC (n = 4059; −US$1755;97.5%CI −US$2495 to −US$986; p < 0.001), where lower risks of PRC and other major complications mediated 10.7% and 7.2% of this association (p < 0.001 and p = 0.015, respectively).
Conclusions |
Intraoperative mechanical ventilation targeting low dynamic driving pressures could be a relevant measure to reduce perioperative healthcare-associated costs in high-risk patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Lower driving pressure is associated with savings in healthcare-associated costs |
• | These observation was made in patients at high risk of respiratory complications. |
• | Postoperative respiratory and other major complications are relevant mediators of the primary association. |
• | Targeting low driving pressure may help reduce healthcare-associated costs for patients at high risk. |
Keywords : Lung-protective ventilation, Driving pressure, Healthcare costs, Postoperative respiratory complications
Plan
| ☆ | Preliminary data of this study were presented at the American Society of Anesthesiologists annual meeting in October 2023 in San Francisco, California, United States of America. |
Vol 98
Article 111567- novembre 2024 Retour au numéro
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