Potential return on investment for implementation of perioperative goal-directed fluid therapy in major surgery: a nationwide database study.
BACKGROUND
Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden. A recent meta-analysis showed a 17-29 % decrease in postoperative morbidity with goal-directed fluid therapy. Our objective was to estimate the potential economic impact of perioperative goal-directed fluid therapy.


METHODS
We studied 204,680 adult patients from 541 US hospitals who had a major non-cardiac surgical procedure between January 2011 and June 2013. Hospital costs (including 30-day readmission costs) in patients with and without complications were extracted from the Premier Inc. research database, and potential cost-savings associated with a 17-29 % decrease in postoperative morbidity were estimated.


RESULTS
A total of 76,807 patients developed one or more postsurgical complications (morbidity rate 37.5 %). In patients with and without complications, hospital costs were US$27,607 ± 32,788 and US$15,783 ± 12,282 (p < 0.0001), respectively. Morbidity rate was anticipated to decrease to 26.6-31.1 % with goal-directed fluid therapy, yielding potential gross cost-savings of US$153-263 million for the study period, US$61-105 million per year, or US$754-1286 per patient. Potential savings per patient were highly variable from one surgical procedure to the other, ranging from US$354-604 for femur and hip-fracture repair to US$3515-5996 for esophagectomies. When taking into account the volume of procedures, the total potential savings per year were the most significant (US$32-55 million) for colectomies.


CONCLUSIONS
Postsurgical complications occurred in more than one third of our study population and had a dramatic impact on hospital costs. With goal-directed fluid therapy, potential cost-savings per patient were US$754-1286. The highest cost-savings per year were observed for colectomies. These projections should help hospitals estimate the return on investment when considering the implementation of goal-directed fluid therapy.
Department of Critical Care, Edwards Lifesciences, 1 Edwards Way, Irvine, CA USA.
Frederic
F
Michard
Premier Inc., Charlotte, NC USA ; Current address: Quintiles, Durham, NC USA.
William K
WK
Mountford
Premier Inc., Charlotte, NC USA ; Current address: Quintiles, Cambridge, MA USA.
Michelle R
MR
Krukas
Premier Inc., Charlotte, NC USA ; Current address: Indegene Total Therapeutic Management, Kennesaw, GA USA.
Frank R
FR
Ernst
Virginia Tech Carilion School of Medicine, Roanoke, VA USA.
Sandy L
SL
Fogel
Complications; Costs; Goal-directed fluid therapy; Return on investment; Savings; Surgery