Clinical Research Director Norton Leatherman Spine Center Louisville, KY, US
Disclosure(s):
Leah Carreon, MD, MSc: No relevant disclosure to display
Introduction: A recent study showed that the use of predictive hemodynamic monitoring (PHM) during posterior spine fusions decreases episodes of intra-operative hypotension, complications and length of stay. It is unclear if the introduction of this new technology leads to cost-savings.
Methods: Adults undergoing elective multi-level instrumented posterior thoracolumbar fusion with arterial line blood pressure monitoring with PHM (N=47) were identified and propensity-matched to those in whom it was not (Non-PHM, N=70). Demographic and surgical data, intra-op and first 4 hours post-op hemodynamic and fluid management data and complications were collected. Cost data were stratified into Surgery (admission to recovery room discharge), Post-operative (recovery room to hospital discharge) and 90-days after discharge.
Results: Propensity matching produced 41 patients each in the PHM and Non-PHM groups who were similar in sex, age, BMI, ASA, surgical levels, estimated blood loss and operative time. The PHM group had a shorter duration of intra-op hypotension (6.6mins vs 13.33mins, p=0.044); and shorter duration of intra-op hypertension (2.4mins vs 6.7mins, p=0.029) compared to the Non-PHM group. Volume of colloids, fluids and blood products transfused intra- and post-operatively were similar. There was a trend towards a lower number of complications per patient in the PHM compared to the Non-PHM group (p=0.053) and a shorter length of stay (4.5 vs 7.0, p=0.011). Surgery costs were similar between the two groups ($41,482 vs $42,264, p=0.853). Post-operative costs were lower in the PHM ($2,757) compared to the Non-PHM group ($5,339, p=0.001), driven mostly by Room & Board ($1,639 vs $3,597, p<.001). Pharmacy ($248 vs $429, p=0.007), Labs ($108 vs $178, p=0.020) and Therapy ($448 vs $877, p=0.003). Costs in the 90 days after discharge were similar between the two groups ($593 vs $438, p=0.574)
Conclusion : The use of PHM decreases intra-operative hemodynamic instability. This is associated with a lower prevalence of complications, decreased length of stay and a potential cost savings of $2,500 per case.