Preoperative spirometry and laparotomy: blowing away dollars.
OBJECTIVE
Increasing evidence indicates that routine preoperative diagnostic spirometry (pulmonary function tests [PFTs]) before elective abdominal surgery does not predict individual risk of postoperative pulmonary complications and is overutilized. This economic evaluation estimates potential savings from reduced use of preoperative PFTs.


METHODS
Analyses of (1) real costs (resource consumption to perform tests) and (2) reimbursements (expenditures for charges) by third-party payers.


METHODS
University-affiliated public and Veterans Affairs hospitals.


METHODS
Adults undergoing elective abdominal operations.


RESULTS
Average real cost of PFTs was $19.07 (95% confidence interval [CI], $18.53 to $19.61), based on a time and motion study. Average reimbursement expenditure by third-party payers for PFTs was $85 (range, $33 to $150; 95% CI, $68 to $103), based on Medicare payment of $52 and a survey of nine urban US hospitals with a spectrum of bed sizes and teaching status. Estimates from published literature included the following: (1) annual number of major abdominal operations, 3.5 million; and (2) proportion of PFTs not meeting current guidelines, 39% (95% CI, 0.31 to 0.47). Local data were used when estimates were not available in the literature: (1) proportion of laparotomies that are elective, 76% (95% CI, 0.73 to 0.79); and (2) frequency of PFTs before laparotomy, 69% (95% CI, 0.54 to 0.84). Estimated annual national real costs for preoperative PFTs are $25 million to $45 million. If use of PFTs were reduced by our estimate for the proportion of PFTs not meeting current guidelines, potential annual national cost savings would be $7,925,411 to $21,406,707. National reimbursement expenditures by third-party payers range from more than $90 million to more than $235 million. If use were reduced, potential annual savings in reimbursements would be $29,084,076 to $111,345,440. Potential savings to Medicare approach $8 million to $20 million annually.


CONCLUSIONS
Reduced use of PFTs before elective abdominal surgery could generate substantial savings. Current evidence indicates reduced use would not compromise patients' outcomes.
De Nino
L A
LA
South Texas Veterans Healthcare System, Audie L. Murphy Division: Geriatric Research, Education and Clinical Center, San Antonio, USA.
Lawrence
V A
VA
Averyt
E C
EC
Hilsenbeck
S G
SG
Dhanda
R
R
Page
C P
CP
D000005:Abdomen / Q000601:surgery; D000328:Adult; D003365:Costs and Cost Analysis / Q000379:methods / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000191:economics / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data; D007813:Laparotomy / Q000191:economics* / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000191:economics* / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013147:Spirometry / Q000191:economics* / Q000706:statistics & numerical data*; D013781:Texas; D014481:United States; D014600:Utilization Review / Q000191:economics