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.
Eisenberg
J M
JM
Section of General Internal Medicine (Department of Medicine), University of Pennsylvania, Philadelphia.
Glick
H A
HA
Buzby
G P
GP
Kinosian
B
B
Williford
W O
WO
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