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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2020

Open Access 01-12-2020 | Public Health | Research article

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

Authors: João M. Silva-Jr, Pedro Ferro L. Menezes, Suzana M. Lobo, Flávia Helena S. de Carvalho, Mariana Augusta N. de Oliveira, Francisco Nilson F. Cardoso Filho, Bruna N. Fernando, Maria Jose C. Carmona, Vanessa D. Teich, Luiz Marcelo S. Malbouisson

Published in: BMC Anesthesiology | Issue 1/2020

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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.
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Metadata
Title
Impact of perioperative hemodynamic optimization therapies in surgical patients: economic study and meta-analysis
Authors
João M. Silva-Jr
Pedro Ferro L. Menezes
Suzana M. Lobo
Flávia Helena S. de Carvalho
Mariana Augusta N. de Oliveira
Francisco Nilson F. Cardoso Filho
Bruna N. Fernando
Maria Jose C. Carmona
Vanessa D. Teich
Luiz Marcelo S. Malbouisson
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Public Health
Published in
BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-020-00987-y

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