Impact on outcome and healthcare costs from hemodynamic optimization in patients undergoing pancreatic surgery: A preliminary report.

Valter Perilli, Paola Aceto, Andrea Russo, Bruno Romanò, Giuseppe Quero, Dario Di Miceli, Sergio Alfieri, Alexandra Maura Berrito, Americo Cicchetti, Liliana Sollazzi

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Aim of this study was to evaluate if the use of a fluid-therapy protocol performed by a minimally-invasive hemodynamic device could improve outcome and reduce healthcare costs in patients undergoing pancreatic surgery.One-hundred-seventy-three patients undergoing pancreatic surgery were included in this before-and-after study. Patients underwent a goal-directed fluid-therapy (GDFT group) regimen by the Vigileo/FloTrac system following NICE (National Institute for Health and Care Excellence) protocol (GDFT, n=69 pts). The control group (CON group) consisted of 104 patients who underwent the same type of surgery in the previous 2 years. In CON group patients fluid-therapy was managed on the basis of conventional hemodynamic parameters. Exclusion criteria were age <18 years, NYHA ≥3 and severe COPD. Primary outcome were the hospital and intensive care length of stay (LOS and ICU-LOS, respectively). Secondary end-points were the reduction of in-hospital morbidity and mortality rate. Budget Impact Analysis (BIA) was also performed.As for primary endpoint, ICU-LOS was significantly shorter in GDFT group (0.4±0.6 vs 1.9 ±0.3; p=0.001); on the contrary, LOS was similar in the two groups (GDFT group: 18.4 ±13.2 and CON group: 18.5±7; p=0.95). Complications rate was significantly less in GDFT group (26.4%) compared to CON group (43%) (p=0.04). There was no difference in mortality rate between the two groups. The use of the protocol leads to an annual saving by 5% of healthcare costs.These findings showed that GDFT based on the NICE protocol lead to a reduction in ICU-LOS as well as postoperative complications in patients undergoing pancreatic surgery with a rather considerable cost-saving. Further studies with a larger sample size are required to confirm our results

Original languageEnglish
Title of host publicationMeMeA 2018 - 2018 IEEE International Symposium on Medical Measurements and Applications, Proceedings
PublisherInstitute of Electrical and Electronics Engineers Inc.
ISBN (Print)9781538633915
DOIs
Publication statusPublished - Aug 16 2018
Event13th IEEE International Symposium on Medical Measurements and Applications, MeMeA 2018 - Rome, Italy
Duration: Jun 11 2018Jun 13 2018

Conference

Conference13th IEEE International Symposium on Medical Measurements and Applications, MeMeA 2018
CountryItaly
CityRome
Period6/11/186/13/18

Keywords

  • fluid therapy
  • hemodynamic optimization
  • high-risk surgery
  • minimally invasive hemodynamic
  • monitoring system
  • pancreatic surgery

ASJC Scopus subject areas

  • Biomedical Engineering
  • Health Informatics
  • Instrumentation

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  • Cite this

    Perilli, V., Aceto, P., Russo, A., Romanò, B., Quero, G., Di Miceli, D., Alfieri, S., Berrito, A. M., Cicchetti, A., & Sollazzi, L. (2018). Impact on outcome and healthcare costs from hemodynamic optimization in patients undergoing pancreatic surgery: A preliminary report. In MeMeA 2018 - 2018 IEEE International Symposium on Medical Measurements and Applications, Proceedings [8438724] Institute of Electrical and Electronics Engineers Inc.. https://doi.org/10.1109/MeMeA.2018.8438724