Hospital resources consumed for surgical morbidity: effects of preoperative arginine and omega-3 fatty acid supplementation on costs.
OBJECTIVE
Costs related to postoperative complications continue to be a major burden on any health care system. The aim of the present study was to calculate hospital costs for postoperative complications and to evaluate whether preoperative supplementation with omega-3 fatty acids and arginine (specialized diet) might lead to cost savings in patient care.


METHODS
Blind analysis of costs performed on data gathered from a randomized clinical trial carried out on 305 patients with gastrointestinal cancer showed that an oral preoperative specialized diet decreased postoperative morbidity compared with conventional treatment (no supplementation). Estimates of complication costs were based on resources used for treatment and on additional length of hospital stay. Cost-comparison and cost-effectiveness analyses were then carried out.


RESULTS
The mean cost of postoperative complications was 4492 pounds sterlings. The greatest amount of resources was consumed by 19 anastomotic leaks (159,803 pounds sterlings), 18 abdominal abscesses (112,921 pounds sterlings), and 18 pancreatic fistulae (106,516 pounds sterlings). The mean costs per complication were 6178 pounds sterlings in the conventional group and 4639 pounds sterlings in the preoperative group (P = 0.05). The mean total costs of patients with complications were 10,494 pounds sterlings in the conventional group and 8793 pounds sterlings in the preoperative group. The mean cost per randomized patient was 3122 pounds sterlings in the conventional group versus 1872 pounds sterlings in the preoperative group (P = 0.04). Effectiveness values were 50.0% in the conventional group and 62.8% in the preoperative group (P = 0.03). Total costs consumed 93% of the diagnosis-related group reimbursement rate in the conventional group and 78% in the preoperative group.


CONCLUSIONS
The costs of postoperative morbidity consumed a large amount of the diagnosis-related group reimbursement rate. Preoperative supplementation with the specialized diet appears to be a cost-effective treatment.
Braga
Marco
M
Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy.
Gianotti
Luca
L
Vignali
Andrea
A
Schmid
Alexandra
A
Nespoli
Luca
L
Di Carlo
Valerio
V
D001120:Arginine / Q000008:administration & dosage*; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements / Q000191:economics*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007167:Immunotherapy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology / Q000401:mortality; D011300:Preoperative Care / Q000191:economics* / Q000379:methods / Q000592:standards; D016032:Randomized Controlled Trials as Topic
D015525:Fatty Acids, Omega-3; D001120:Arginine