Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy.
OBJECTIVE
To evaluate the cost-effectiveness balance of implementing an intensive program of chest physiotherapy in pulmonary lobectomy.


METHODS



METHODS
cross-sectional study with historical controls. Cases are 119 patients operated on during a 15-month period of time, after implementation of an intensive chest-physiotherapy program. Controls are 520 patients operated on by the same team before the program started. In these patients, only incentive spirometry was indicated besides routine nursing care. In both series, operative selection criteria and anaesthetic management were similar. Population homogeneity was assessed by comparing age, body mass index (BMI) and estimated postoperative FEV1 (ppoFEV1) of the patients in both series. Selected outcomes were as follows: 30-day mortality, prevalence of respiratory morbidity (atelectasis and pneumonia) and hospital stay. Hospital stay was estimated by Cox regression using age, ppoFEV1, BMI, diagnosis and postoperative morbidity as covariates. Costs were calculated adding chest therapists' salaries and acquisition value of specific training and monitoring devices and its consumable items. Savings from avoided hospitalisation days was discounted.


RESULTS
Prevalence of atelectasis and median hospital stay decreased in physiotherapy group. Cost of the program was 48,447.81 (407.12 per treated patient). An estimated total of 151.75 hospital days was saved in the physiotherapy group. Since daily hospitalisation cost is 590.00 in our centre, 89,532.50 savings was estimated from avoided hospitalisation days.


CONCLUSIONS
We have found a significant decrease in the rate of postoperative atelectasis without additional costs. In fact, the program has produced considerable monetary savings.
Varela
Gonzalo
G
Section of Thoracic Surgery, Salamanca University Hospital, 37007 Salamanca, Spain. gvs@usal.es
Ballesteros
Esther
E
Jiménez
Marcelo F
MF
Novoa
Nuria
N
Aranda
José L
JL
D000368:Aged; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D026741:Physical Therapy Modalities / Q000191:economics*; D011013:Pneumonectomy / Q000379:methods*; D011184:Postoperative Period; D011300:Preoperative Care / Q000191:economics; D001261:Pulmonary Atelectasis; D012044:Regression Analysis