Does perioperative total parenteral nutrition reduce medical care costs?
An economic analysis accompanied a multicenter Department of Veterans Affairs randomized, controlled trial of perioperative total parenteral nutrition (TPN). The cost of providing TPN for an average of 16.15 days before and after surgery was $2405, more than half of which ($1025) included costs of purchasing, preparing, and delivering the TPN solution itself; lipid solutions accounted for another $181, additional nursing care for $843, and miscellaneous costs for $356. Prolonged hospital stay added another $764 per patient to the $2405 cost of providing TPN, bringing the total to $3169. The incremental costs attributed to perioperative TPN were highest ($3921) for the patients least likely to benefit, that is, those who were less malnourished and at low risk of nutrition-related complications. Incremental costs were lowest ($3071) for high-risk patients. On the basis of the hospital-based method of administering TPN that was used in the clinical trial, perioperative TPN did not result in decreased costs for any subgroup of patients.
Section of General Internal Medicine (Department of Medicine), University of Pennsylvania, Philadelphia.
J M
JM
Eisenberg
H A
HA
Glick
G P
GP
Buzby
B
B
Kinosian
W O
WO
Williford
D002404:Catheterization / Q000191:economics; D004334:Drug Administration Schedule; D016527:Drug Costs; D004471:Economics, Nursing; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D015596:Nutrition Assessment; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D011182:Postoperative Care / Q000191:economics*; D011300:Preoperative Care / Q000191:economics*; D012996:Solutions / Q000191:economics; D013514:Surgical Procedures, Operative / Q000191:economics
D012996:Solutions