[Economic impact of the consensus conference guidelines on postoperative artificial nutrition in the Rhone-Alps region].
OBJECTIVE
To assess the economic impact of the French guidelines produced by the 1994 consensus conference on postoperative artificial nutrition (AN) in elective surgery.


METHODS
Multicentre before-after study, conducted on a cost-containment model from the hospital perspective.


METHODS
Ten hospitals were randomly selected in the Rhône-Alpes area, after a stratification of hospital category. Twenty consecutive patients, who underwent upper and lower abdominal surgery in each hospital, were included over each study period. Data were collected on site by investigators from patients' records before (1994) and after (1995) guidelines had been circulated. The calculated costs were direct and partial medical and non medical staff costs of a one-day parenteral nutrition. They included nutrients, disposable devices, staff time and laboratory tests.


RESULTS
Between 1994 and 1995, the study showed a 7.4% decrease in the postoperative prescription rate of AN, a 4.7% increase in the duration of AN and a 3.6% (FF 74.07 constant francs per patient) increase in the total cost of AN in surgical patients. Guidelines had mainly a positive impact in patients suffering from denutrition, as the duration of postoperative AN increased by 23.7% in this group, leading to a 65.1% (FF 175.53) increase in cost in 1995.


CONCLUSIONS
The cost variable is a valuable indicator of the impact of practice guidelines, as it includes the rate and duration of prescriptions. The consensus conference had a significant impact in patients suffering from denutrition. Conversely, only minor changes in practices concerning patients non suffering from denutrition have been observed, leading to a slight cost increase in AN.
Misrahi
L
L
Département d'information médicale, Hôtel-Dieu, Hospices Civils de Lyon, France.
Colin
C
C
Lanoir
D
D
Chambrier
C
C
Jolivet
A
A
Boulétreau
P
P
D000368:Aged; D003245:Consensus Statements as Topic; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures; D005260:Female; D005602:France; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D010288:Parenteral Nutrition / Q000191:economics* / Q000592:standards; D011182:Postoperative Care / Q000191:economics* / Q000592:standards; D011785:Quality Assurance, Health Care; D012680:Sensitivity and Specificity