TY - JOUR
T1 - Association of perioperative hypotension with subsequent greater healthcare resource utilization
AU - Stapelfeldt, Wolf H.
AU - Khanna, Ashish K.
AU - Shaw, Andrew D.
AU - Shenoy, Apeksha V.
AU - Hwang, Seungyoung
AU - Stevens, Mitali
AU - Smischney, Nathan J.
N1 - Funding Information:
This work was financially supported by Edwards Lifesciences.
Funding Information:
Wolf H. Stapelfeldt, Ashish K. Khanna, Andrew D. Shaw, and Nathan J. Smischney have received consulting fees from Edwards Lifesciences. Apeksha V. Shenoy and Seungyoung Hwang are employees of Boston Strategic Partners, who received funds from Edwards Lifesciences to perform the research. Mitali Stevens is an employee of Edwards Lifesciences. Ashish K. Khanna consults for Medtronic and Potrero Medical. Ashish K. Khanna is supported by a NIH/NCATS Wake Forest University CTSI KL2 award TR001421 for a pilot trial of continuous portable postoperative hemodynamic and saturation monitoring on hospital wards.
Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - Study objective: Determine if perioperative hypotension, a modifiable risk factor, is associated with increased postoperative healthcare resource utilization (HRU). Design: Retrospective cohort study. Setting: Multicenter using the Optum® electronic health record database. Patients: Patients discharged to the ward after non-cardiac, non-obstetric surgeries between January 1, 2008 and December 31, 2017 with six months of data, before and after the surgical visit. Interventions/Exposure: Perioperative hypotension, a binary variable (presence/absence) at an absolute MAP of ≤65-mmHg, measured during surgery and within 48-h after, to dichotomize patients with greater versus lesser hypotensive exposures. Measurements: Short-term HRU defined by postoperative length-of-stay (LOS), discharge to a care facility, and 30-day readmission following surgery discharge. Mid-term HRU (within 6 months post-discharge) quantified via number of outpatient and emergency department (ED) visits, and readmission LOS. Main results: 42,800 distinct patients met study criteria and 37.5% experienced perioperative hypotension. After adjusting for study covariates including patient demographics and comorbidities, patients with perioperative hypotension had: longer LOS (4.01 vs. 3.83 days; LOS ratio, 1.05; 95% CI, 1.04–1.06), higher odds of discharge to a care facility (OR, 1.18; 95% CI, 1.12–1.24; observed rate 22.1% vs. 18.1%) and of 30-day readmission (OR, 1.22; 95% CI, 1.11–1.33; observed rate 6.2% vs. 5.0%) as compared to the non-hypotensive population (all outcomes, p < 0.001). During 6-month follow-up, patients with perioperative hypotension showed significantly greater HRU regarding number of ED visits (0.34 vs. 0.31 visits; visit ratio, 1.10; 95% CI, 1.05–1.15) and readmission LOS (1.06 vs. 0.92 days; LOS ratio, 1.15; 95% CI, 1.07–1.24) but not outpatient visits (10.47 vs. 10.82; visit ratio, 0.97; 95% CI, 0.95–0.99) compared to those without hypotension. There was no difference in HRU during the 6-month period before qualifying surgery. Conclusions: We report a significant association of perioperative hypotension with an increase in HRU, including additional LOS and readmissions, both important contributors to overall medical costs.
AB - Study objective: Determine if perioperative hypotension, a modifiable risk factor, is associated with increased postoperative healthcare resource utilization (HRU). Design: Retrospective cohort study. Setting: Multicenter using the Optum® electronic health record database. Patients: Patients discharged to the ward after non-cardiac, non-obstetric surgeries between January 1, 2008 and December 31, 2017 with six months of data, before and after the surgical visit. Interventions/Exposure: Perioperative hypotension, a binary variable (presence/absence) at an absolute MAP of ≤65-mmHg, measured during surgery and within 48-h after, to dichotomize patients with greater versus lesser hypotensive exposures. Measurements: Short-term HRU defined by postoperative length-of-stay (LOS), discharge to a care facility, and 30-day readmission following surgery discharge. Mid-term HRU (within 6 months post-discharge) quantified via number of outpatient and emergency department (ED) visits, and readmission LOS. Main results: 42,800 distinct patients met study criteria and 37.5% experienced perioperative hypotension. After adjusting for study covariates including patient demographics and comorbidities, patients with perioperative hypotension had: longer LOS (4.01 vs. 3.83 days; LOS ratio, 1.05; 95% CI, 1.04–1.06), higher odds of discharge to a care facility (OR, 1.18; 95% CI, 1.12–1.24; observed rate 22.1% vs. 18.1%) and of 30-day readmission (OR, 1.22; 95% CI, 1.11–1.33; observed rate 6.2% vs. 5.0%) as compared to the non-hypotensive population (all outcomes, p < 0.001). During 6-month follow-up, patients with perioperative hypotension showed significantly greater HRU regarding number of ED visits (0.34 vs. 0.31 visits; visit ratio, 1.10; 95% CI, 1.05–1.15) and readmission LOS (1.06 vs. 0.92 days; LOS ratio, 1.15; 95% CI, 1.07–1.24) but not outpatient visits (10.47 vs. 10.82; visit ratio, 0.97; 95% CI, 0.95–0.99) compared to those without hypotension. There was no difference in HRU during the 6-month period before qualifying surgery. Conclusions: We report a significant association of perioperative hypotension with an increase in HRU, including additional LOS and readmissions, both important contributors to overall medical costs.
KW - Emergency department visit
KW - Healthcare resource utilization
KW - Length of stay
KW - Non-cardiac surgery
KW - Outpatient visit
KW - Perioperative hypotension
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U2 - 10.1016/j.jclinane.2021.110516
DO - 10.1016/j.jclinane.2021.110516
M3 - Article
C2 - 34536719
AN - SCOPUS:85114913799
SN - 0952-8180
VL - 75
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
M1 - 110516
ER -