[Show abstract][Hide abstract] ABSTRACT: Objective: Cost comparison between three common anesthetic agents. Design: Retrospective analysis. Patients had been randomized to anesthetic maintenance with either desflurane, sevoflurane, or propofol. Setting: Operating room in an academic medical center Patients: 103 patients undergoing general endotracheal anesthesia. Patients were ASA class I-III and between 18 and 75 years old. Cardiac, Neurologic, and regional cases were excluded. Outcome Measures: Volatile anesthetic cost was determined using the following formula: Cost = [(concentration) (FGF)(duration)(MW)(cost/ml)]/[2412)(D)]. To determine propofol cost, average infusion rate (mcg/kg/min.), patient weight, and duration were measured. Cost for each agent was then divided by surgical time to compare the results on a cost/min. basis. Results: Per minute of surgery, propofol was the least expensive agent for anesthetic maintenance at $0.12/min. Sevoflurane cost $0.18/min and desflurane cost $0.48/min. The differences between all three agents were statistically significant (p <0.05). Propofol maintenance was associated with a higher intra-operative fentanyl dose. The average fentanyl dose in the propofol group was 468 mcg, sevoflurane was 321 mcg, and desflurane was 284 mcg. There was no association between intra-operative fentanyl dose and anesthetic maintenance cost per minute of surgery. Surgical time did not significantly differ between the three groups and averaged over three hours. Conclusion: Anesthetic maintenance with propofol may help peri-operative physicians deliver care in the most cost effective manner possible.. Anesthetic maintenance with propofol infusion is less expensive per minute of surgery than sevoflurane or desflurane.
Anaesthesia, Pain and Intensive Care 09/2014; 17(September to December 2013):17(3):248-251.
[Show abstract][Hide abstract] ABSTRACT: Objective: To examine the impact of intravenous antihypertensive selection on hospital health resource utilization using data from the Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events (ECLIPSE) trials. Methods: Analysis of ECLIPSE trial data comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine and unit costs based on the Premier Hospital database to assess surgery duration, time to extubation, and length of stay (LOS) with the associated cost. Results: A total of 1414 patients from the ECLIPSE trials and the Premier hospital database were included for analysis. The duration of surgery and postoperative LOS were similar across groups. The time from chest closure to extubation was shorter in patients receiving clevidipine group compared with the pooled comparator group (median 7.0 vs 7.6 hours, P = 0.04). There was shorter intensive care unit (ICU) LOS in the clevidipine group versus the nitroglycerin group (median 27.2 vs 33.0 hours, P = 0.03). A trend toward reduced ICU LOS was also seen in the clevidipine compared with the pooled comparator group (median 32.3 vs 43.5 hours, P = 0.06). The costs for ICU LOS and time to extubation were lower with clevidipine than with the comparators, with median cost savings of $887 and $34, respectively, compared with the pooled comparator group, for a median cost savings of $921 per patient. Conclusions: Health resource utilization across therapeutic alternatives can be derived from an analysis of standard costs from hospital financial data to matched utilization metrics as part of a randomized controlled trial. In cardiac surgical patients, intravenous antihypertensive selection was associated with a shorter time to extubation in the ICU and a shorter ICU stay compared with pooled comparators, which in turn may decrease total costs.
[Show abstract][Hide abstract] ABSTRACT: To examine the impact of blood pressure control on hospital health resource utilization using data from the ECLIPSE trials.
Post-hoc analysis of data from 3 prospective, open-label, randomized clinical trials (ECLIPSE trials).
Sixty-one medical centers in the United States.
Patients 18 years or older undergoing cardiac surgery.
Clevidipine was compared with nitroglycerin, sodium nitroprusside, and nicardipine.
The ECLIPSE trials included 3 individual randomized open-label studies comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine. Blood pressure control was assessed as the integral of the cumulative area under the curve (AUC) outside specified systolic blood pressure ranges, such that lower AUC represents less variability. This analysis examined surgery duration, time to extubation, as well as intensive care unit (ICU) and hospital length of stay (LOS) in patients with AUC≤10 mmHg×min/h compared to patients with AUC>10 mmHg×min/h. One thousand four hundred ten patients were included for analysis; 736 patients (52%) had an AUC≤10 mmHg×min/h, and 674 (48%) had an AUC>10 mmHg×min/h. The duration of surgery and ICU LOS were similar between groups. Time to extubation and postoperative LOS were both significantly shorter (p = 0.05 and p<0.0001, respectively) in patients with AUC≤10. Multivariate analysis demonstrates AUC≤10 was significantly and independently associated with decreased time to extubation (hazard ratio 1.132, p = 0.0261) and postoperative LOS (hazard ratio 1.221, p = 0.0006).
Based on data derived from the ECLIPSE studies, increased perioperative BP variability is associated with delayed time to extubation and increased postoperative LOS.
Journal of cardiothoracic and vascular anesthesia 04/2014; · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few studies describe an association of perioperative blood pressure stability with postoperative outcome. We tested the hypothesis that systolic blood pressure (SBP) variability in patients undergoing cardiac surgery is associated with 30-day mortality.
Perioperative blood pressure variability was evaluated in the 1512 patients who were randomized and had perioperative hypertension in the ECLIPSE trials. Blood pressure variability was assessed as the product of magnitude × duration of SBP excursions outside defined SBP ranges (area under the curve). SBP ranges were analyzed from 65 to 135 mm Hg intraoperatively and 75 to 145 mm Hg pre- or postoperatively, up to 105 to 135 mm Hg intraoperatively and 115 to 145 mm Hg pre- or postoperatively, with the narrower ranges defined by progressively increasing the lower SBP limit by 10 mm Hg increments. Multiple logistic regression was used to assess the association of blood pressure variability with 30-day mortality obtained from the primary ECLIPSE trial results.
Increased SBP variability outside a range of 75 to 135 mm Hg intraoperatively and 85 to 145 mm Hg pre- and postoperatively is significantly associated with 30-day mortality. The odds ratio was 1.16 (95% confidence interval, 1.04-1.30) for 30-day mortality risk per incremental SBP excursion of 60 mm Hg × min/h. The predicted probability of 30-day mortality increased for low-risk patients from 0.2% to 0.5%, and for high-risk patients from 42.4% to 60.7% if the area under the curve increased from 0 to 300 mm Hg × min/h.
Perioperative blood pressure variability is associated with 30-day mortality in cardiac surgical patients, proportionate to the extent of SBP excursions outside the range of 75 to 135 mm Hg intraoperatively and 85 to 145 mm Hg pre- and postoperatively. Predicted mortality was greater for high-risk patients than for low-risk patients.
Anesthesia and analgesia 02/2011; 113(1):19-30. · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient.We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium.
After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl.The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale) preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation.Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight) and to the preoperative score index for delirium.
The results of this comparative anaesthesiological trial should whether each the three hypnotics tested is related to a significantly different postoperative delirium rate. This information could ultimately allow us to select the most appropriate hypnotic to maintain anaesthesia for specific subgroups of patients and especially for those at high risk of postoperative delirium. REGISTERED AT TRIAL.GOV NUMBER: ClinicalTrials.gov: NCT00507195.