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The Cost Efficacy of Hypothetically Eliminating Adverse Anesthetic Outcomes from High-Risk, but Neither Low- nor Moderate-Risk, Surgical Operations

We tested whether hypothetical improvements in the quality of perioperative care can decrease hospital costs for elective surgical operations.Our case series was constructed retrospectively of consecutive patients who underwent one of the following elective operations at our tertiary care center: lung lobectomy (137), coronary artery bypass (339), kidney transplant (251), total hip replacement (305), laparoscopic cholecystectomy (203), or cesarean section (649). Only hospital costs were included in our study. Eliminating adverse anesthetic outcomes (identified by chart review) entirely would decrease total hospital costs (i.e., for all patients in that group) by less than 0.5% (95% confidence bound <1.2%) for kidney transplant, 1.8% (<3.5%) for total hip replacement, 0% for laparoscopic cholecystectomy, and 2.2% (<6.2%) for cesarean section. In contrast, a hypothetical quality improvement that would have the effect of decreasing costs for the 10% most expensive patients just to the group median would decrease total costs by 30% (15%-44%) for lung lobectomy and 16% (10%-21%) for coronary artery bypass. We conclude that for low- and moderate-risk procedures, hypothetical improvements in the quality of anesthetic care will not reduce costs. However, improving the quality of perioperative care may be cost efficient for high-risk operations. (Anesth Analg 1995;81:939-44)