Low fresh gas flow balanced anesthesia versus target controlled intravenous infusion anesthesia in laparoscopic cholecystectomy: a cost-minimization analysis.
BACKGROUND
Laparoscopic surgery is widely recognized as a well-tolerated and effective method for cholecystectomy. It is also considered cost saving because it has been associated with a decreased hospital length of stay. Variables that might lead to increased costs in laparoscopic surgery are the technique and drugs used in anesthesia.


OBJECTIVE
The goal of this study was to compare the costs of 2 anesthetic techniques used in laparoscopic cholecystectomy (LC)--balanced versus IV anesthesia--from the standpoint of an outpatient surgical department, with a time horizon of 1 year.


METHODS
Patients scheduled to undergo elective LC were enrolled in this prospective case study. Patients were randomly allocated to receive balanced anesthesia, administered as low fresh gas flow (LFGF) with inhalational sevoflurane and IV sufentanil in a target controlled infusion (LFGF SS group), or IV anesthesia, administered as IV propofol/sufentanil in a target controlled infusion (TCI group). We used a microcosting procedure to measure health care resource utilization in individual patients to detect treatment differences. The costs of medications used for the induction and maintenance of anesthesia during surgery were considered for LFGF SS and TCI. Other end points included duration of anesthesia; mean times to early emergence, tracheal extubation, orientation, and postanesthesia discharge (PAD); pain intensity before first analgesia; number of analgesics required in the first 24 hours after surgery; and prevalences of nausea, vomiting, and agitation.


RESULTS
A total of 60 patients were included in this analysis (male/female ratios in the LFGF SS and TCI groups: 11/19 and 12/18, respectively; mean [SD] ages, 48 [7.9] and 47 [8.6] years; and mean [SD] body mass indexes, 26 [2.0] and 26 [3.0] kg/m2). The costs of anesthetics were significantly lower with LFGF SS compared with TCI (euro17.40 [euro2.66] vs euro22.01 [euro2.50] [2006 euros]). Times to early emergence and tracheal extubation were significantly shorter with LFGF SS than TCI (5.97 [1.16] vs 7.73 [1.48] minutes and 7.57 [1.07] vs 8.87 [1.45] minutes, respectively). There were no significant between-group differences in mean duration of anesthesia; times to orientation and PAD; pain intensity before first analgesia; number of analgesics required in the first 24 hours; or prevalences of nausea, vomiting, and agitation. Because no clinically significant differences in the anesthetic results were observed, a cost-minimization analysis was conducted and found that using LFGF SS, the outpatient surgical department could realize a budget savings of euro454 per 100 patients. For the nearly 1000 expected patients per year, the savings for the department was calculated as euro4540.


CONCLUSIONS
The results from this cost analysis in these patients who underwent elective LC suggest that the use of sevoflurane through the LFGF technique would be cost saving in this outpatient surgical department.
Clinic of Anaesthesiology and Reanimatology, Clinical Center "Dr D. Misovic"-DEDINJE, University of Belgrade, Belgrade, Republic of Serbia. batica@eunet.yu
Predrag D
PD
Stevanovic
Guenka
G
Petrova
Branislava
B
Miljkovic
Radisav
R
Scepanovic
Radoslav
R
Perunovic
Dragos
D
Stojanovic
Janja
J
Dobrasinovic
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000191:economics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D003365:Costs and Cost Analysis / Q000191:economics*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000191:economics*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D011446:Prospective Studies; D000077149:Sevoflurane; D017409:Sufentanil / Q000191:economics / Q000627:therapeutic use
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D017409:Sufentanil; D015742:Propofol