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

Fingerprint

hemodynamics
Hemodynamics
surgery
Intensive care units
Health Care Costs
Surgery
costs
optimization
Fluid Therapy
Fluids
Costs
Control Groups
National Institutes of Health (U.S.)
Health
therapy
mortality
Delivery of Health Care
Mortality
health
Budgets

Keywords

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

ASJC Scopus subject areas

  • Biomedical Engineering
  • Health Informatics
  • Instrumentation

Cite this

Perilli, V., Aceto, P., Russo, A., Romanò, B., Quero, G., Di Miceli, D., ... 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

Impact on outcome and healthcare costs from hemodynamic optimization in patients undergoing pancreatic surgery : A preliminary report. / Perilli, Valter; Aceto, Paola; Russo, Andrea; Romanò, Bruno; Quero, Giuseppe; Di Miceli, Dario; Alfieri, Sergio; Berrito, Alexandra Maura; Cicchetti, Americo; Sollazzi, Liliana.

MeMeA 2018 - 2018 IEEE International Symposium on Medical Measurements and Applications, Proceedings. Institute of Electrical and Electronics Engineers Inc., 2018. 8438724.

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

Perilli, V, Aceto, P, Russo, A, Romanò, B, Quero, G, Di Miceli, D, Alfieri, S, Berrito, AM, 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., 13th IEEE International Symposium on Medical Measurements and Applications, MeMeA 2018, Rome, Italy, 6/11/18. https://doi.org/10.1109/MeMeA.2018.8438724
Perilli V, Aceto P, Russo A, Romanò B, Quero G, Di Miceli D et al. 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. Institute of Electrical and Electronics Engineers Inc. 2018. 8438724 https://doi.org/10.1109/MeMeA.2018.8438724
Perilli, Valter ; Aceto, Paola ; Russo, Andrea ; Romanò, Bruno ; Quero, Giuseppe ; Di Miceli, Dario ; Alfieri, Sergio ; Berrito, Alexandra Maura ; Cicchetti, Americo ; Sollazzi, Liliana. / Impact on outcome and healthcare costs from hemodynamic optimization in patients undergoing pancreatic surgery : A preliminary report. MeMeA 2018 - 2018 IEEE International Symposium on Medical Measurements and Applications, Proceedings. Institute of Electrical and Electronics Engineers Inc., 2018.
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N2 - 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

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