Tackling the burden of postsurgical complications in the USA: would perioperative goal-directed therapy help?

Introduction

Pay-for-performance programs and economic constraints call for solutions improving the quality of healthcare without increasing costs. Many studies have shown decreased morbidity in major surgery when perioperative goal-directed therapy (PGDT) is used. We assessed the clinical and economic burden of postsurgical complications in the University HealthSystem Consortium (UHC) in order to predict potential savings with PGDT.

Methods

Data from adults who had 10 major surgical procedures in 2011 were screened in the UHC database. Thirteen postsurgical complications were tabulated. In-hospital mortality, hospital length of stay and costs from patients with and without complications were compared. The risk ratios reported by the most recent meta-analysis were used to estimate the potential reduction in postsurgical morbidity with PGDT. Potential cost savings were calculated from the actual and anticipated morbidity rates.

Results

A total of 75,140 patients met the search criteria. In total, 8,421 patients developed one or more postsurgical complications (morbidity rate 11.2%). In-hospital mortality was 12.42% and 1.39% (P < 0.001), mean hospital length of stay was 20.48 ± 20.09 days and 8.5 ± 7.11 days (P < 0.001), and mean direct cost was $47,284 ± 49,170 and $17,408 ± 15,612 (P < 0.001) in patients with and without complications, respectively. With PGDT, morbidity rate was projected to decrease to 6.5 to 9.0%, yielding gross costs savings of $50 million to 151 million for the study population or $670 to $1,406 per patient.

Conclusion

Postsurgical complications have a dramatic impact on mortality, hospital length of stay and costs. Potential cost savings resulting from PGDT are substantial. PGDT may be recommended to improve quality of care and decrease costs.