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Return on investment for implementation of perioperative goal-directed therapy in major surgery: a nationwide database study


Preventable postsurgical complications are increasingly recognized as a major healthcare burden. A recent meta-analysis showed a 17 to 29% decrease in complications after major surgery with perioperative goal-directed therapy (PGDT) [1]. We assessed the financial consequences of postsurgical complications in a large population from 541 US hospitals in order to predict potential savings with PGDT.


Data from adults who had any one of 10 major noncardiac surgical procedures between January 2011 and June 2013 were selected from the Premier research database. Twenty-six postsurgical complications were tabulated. Hospital costs, length of stay, and readmission rates were compared in patients with and without complications. Risk ratios reported by Pearse's meta-analysis were used to estimate the expected reduction in postsurgical morbidity with PGDT. Potential cost-savings were calculated from the actual and anticipated morbidity rates using the mean difference in total costs.


A total of 204,680 patients met the search criteria, and 76,807 patients developed one or more postsurgical complications (morbidity rate 37.5%). In patients with and without complications, hospital costs (including 30 days readmission costs) were $27,607 ± 32.788 and $15.783 ± 12,282 (P < 0.0001), median (interquartile range) hospital lengths of stay (first stay) were 7 (4 to 10) days and 4 (3 to 5) days (P < 0.0001), and 30-day readmission rates were 17.2% and 11.9% (P < 0.0001), respectively. With PGDT, the morbidity rate was anticipated to decrease from 26.6 to 31.1%, yielding gross cost savings of $153 million to 263 million for the study period, $61 million to 105 million per year, or $754 to 1,286 per patient.


Postsurgical complications occurred in more than one-third of our study population and had a dramatic impact on hospital costs, length of stay, and readmission rates. Potential cost savings with PGDT were $754 to 1,286 per patient. These projections should help hospitals estimate the return on investment for implementation of PGDT.


  1. Pearse , et al: Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014, 2181-90. 311

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Michard, F., Krukas, M., Ernst, F. et al. Return on investment for implementation of perioperative goal-directed therapy in major surgery: a nationwide database study. Crit Care 19 (Suppl 1), P186 (2015).

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  • Hospital Cost
  • Morbidity Rate
  • Readmission Rate
  • Potential Cost Saving
  • Expected Reduction