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Research article
João M Silva-Jr
Universidade de São Paulo
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1494-0784
License:
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Background: Several studies suggest that hemodynamic optimization therapies can reduce complication, length of hospital stay and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health system. Method: A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients submitted to standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs (equipment depreciation, estate and management activities) were not included in the analysis. Results: A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR=0.66; 95% CI=0.58-0.74), renal (RR=0.68; 95% CI=0.54-0.87), and cardiovascular complications (RR=0.87; 95% CI=0.76-0.99) and a non-statistically significant lower rate of respiratory complications (RR=0.82; 95% CI=0.67-1.02). There was no difference in mortality (RR=1.02; 95% CI=0.80-1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83-BRL ($90,161.38-USD) for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer day in the ICU and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47-BRL ($371,173.27-USD) for every 1000 patients treated. Conclusions: Hemodynamic optimization therapy is cost-effective and would increase efficiency and decrease the burden of the Brazilian public health system.
Keywords
surgery, hemodynamic optimization, complications, economic, cost-effective, public health system
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CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
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Editorial decision: Accept
On 20 Mar, 2020
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Editorial decision: Minor revision
On 16 Mar, 2020
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On 15 Mar, 2020
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On 14 Mar, 2020
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On 14 Mar, 2020
Version 2
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Review #1 received
Received 08 Mar, 2020
Editorial decision: Minor revision
On 08 Mar, 2020
Reviewer #2 agreed
On 06 Mar, 2020
Review #2 received
Received 06 Mar, 2020
Reviewer #1 agreed
On 05 Mar, 2020
Reviewers invited
Invitations sent on 03 Mar, 2020
Editor assigned
On 02 Mar, 2020
Submission checks complete
On 01 Mar, 2020
Editor invited
On 01 Mar, 2020
No comments provided
Review #1 received
Received 10 Feb, 2020
Editorial decision: Minor revision
On 10 Feb, 2020
Reviewer #2 agreed
On 09 Feb, 2020
Review #2 received
Received 09 Feb, 2020
Reviewer #1 agreed
On 22 Jan, 2020
Editor assigned
On 21 Jan, 2020
Reviewers invited
Invitations sent on 21 Jan, 2020
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On 20 Jan, 2020
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On 20 Jan, 2020
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Subject Areas
Anesthesiology & Pain Medicine
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See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
João M Silva-Jr
Universidade de São Paulo
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1494-0784
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
No community comments so far
Submission checks complete
On 20 Mar, 2020
Editorial decision: Accept
On 20 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 16 Mar, 2020
Editor assigned
On 15 Mar, 2020
Submission checks complete
On 14 Mar, 2020
Editor invited
On 14 Mar, 2020
Version 2
Posted 03 Mar, 2020
No comments provided
Review #1 received
Received 08 Mar, 2020
Editorial decision: Minor revision
On 08 Mar, 2020
Reviewer #2 agreed
On 06 Mar, 2020
Review #2 received
Received 06 Mar, 2020
Reviewer #1 agreed
On 05 Mar, 2020
Reviewers invited
Invitations sent on 03 Mar, 2020
Editor assigned
On 02 Mar, 2020
Submission checks complete
On 01 Mar, 2020
Editor invited
On 01 Mar, 2020
No comments provided
Review #1 received
Received 10 Feb, 2020
Editorial decision: Minor revision
On 10 Feb, 2020
Reviewer #2 agreed
On 09 Feb, 2020
Review #2 received
Received 09 Feb, 2020
Reviewer #1 agreed
On 22 Jan, 2020
Editor assigned
On 21 Jan, 2020
Reviewers invited
Invitations sent on 21 Jan, 2020
Submission checks complete
On 20 Jan, 2020
Editor invited
On 20 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
Background: Several studies suggest that hemodynamic optimization therapies can reduce complication, length of hospital stay and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health system. Method: A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients submitted to standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs (equipment depreciation, estate and management activities) were not included in the analysis. Results: A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR=0.66; 95% CI=0.58-0.74), renal (RR=0.68; 95% CI=0.54-0.87), and cardiovascular complications (RR=0.87; 95% CI=0.76-0.99) and a non-statistically significant lower rate of respiratory complications (RR=0.82; 95% CI=0.67-1.02). There was no difference in mortality (RR=1.02; 95% CI=0.80-1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83-BRL ($90,161.38-USD) for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer day in the ICU and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47-BRL ($371,173.27-USD) for every 1000 patients treated. Conclusions: Hemodynamic optimization therapy is cost-effective and would increase efficiency and decrease the burden of the Brazilian public health system.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
This is a list of supplementary files associated with this preprint. Click to download.
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