title: Esophageal Doppler monitoring during colorectal resection offers cost-effective improvement of hemodynamic control.
abstract: OBJECTIVE
  Hemodynamic control can improve the outcome of surgery. Esophageal Doppler monitoring measures blood flow by ultrasound waves. This work investigates the cost-effectiveness of this procedure during colorectal resection.
  
  
  METHODS
  Meta-analyses of randomized controlled trials of esophageal Doppler monitoring used in colorectal resection were conducted to help determine its cost-effectiveness. An analytical decision model was used to compare the cost-effectiveness of strategies involving conventional clinical assessment with or without the measurement of central venous pressure, with or without esophageal Doppler monitoring. Avoided mortality and avoided major complications were used as measures of clinical effectiveness.
  
  
  RESULTS
  In the meta-analyses comparing conventional clinical assessment plus central venous pressure monitoring with or without esophageal Doppler monitoring, statistically significant differences in total and major complications favoring the use of Doppler were found. No differences were seen in mortality. The use of esophageal Doppler monitoring was associated with lower costs, mainly due to fewer complications, shorter hospital stays and shorter surgery times.
  
  
  CONCLUSIONS
  Although the information regarding the clinical effectiveness of esophageal Doppler monitoring in colorectal resection is limited, strategies including this form of blood flow monitoring may be cost-effective. Further comparisons of Doppler monitoring against other hemodynamic monitoring systems should be undertaken.
authors.affiliation: Health Technology Assessment Unit, Agencia Laín Entralgo, Madrid, Spain. smaemar@hotmail.com
authors.forename: Sergio
authors.initials: S
authors.lastname: Maeso
authors.forename: Daniel
authors.initials: D
authors.lastname: Callejo
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Hernández
authors.forename: Juan A
authors.initials: JA
authors.lastname: Blasco
authors.forename: Elena
authors.initials: E
authors.lastname: Andradas
mesh_terms: D003108:Colonic Diseases / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging*; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012002:Rectal Diseases / Q000601:surgery*; D018608:Ultrasonography, Doppler