Economic aspects of perioperative respiratory events: a study in children

Your patient’s oxygen saturation was < 95% for more than 10 seconds or perhaps your patient had laryngospasm during induction of anesthesia. Does it cost more to care for that patient?

Dr. Maliwan Oofuvong, Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand, and colleagues describe a prospective matched cohort study of the economic costs associated with a perioperative respiratory event (desaturation, laryngospasm, bronchospasm, reintubation) in children undergoing anesthesia in Thailand. The results of their analysis are summarized in the article “Excess Costs and Length of Hospital Stay Attributable to Perioperative Respiratory Events in Children” that was published in this month’s issue of Anesthesia & Analgesia.

The study population was drawn from a single large hospital and included children who experienced a perioperative respiratory event during anesthesia and a matched group of control patients undergoing similar operations. A total of 215 matched pairs were compared. A mixed effects linear regression model was used to identify predictors of adjusted excess hospital cost and indirect cost to the parents and family.

More children with a respiratory event required admission (81% vs. 72%). Overall hospital stays were longer in children with respiratory events. Hospital costs were higher in children with perioperative respiratory events compared to the matched controls. Indirect (family) costs were 58% higher in outpatients only but for inpatients indirect costs were no different.

These findings confirm the experience of most anesthesiologists that children with upper respiratory complications require more intensive management. The study advances our knowledge by putting an economic cost on this common complication: as much as 30% higher hospital expenses. The authors suggest a need to adjust hospital budgets and bed management , but they do not explore the question of prevention. Deferring surgery in high-risk children (e.g., those recovering from upper respiratory infection) or changing intraoperative anesthesia management (e.g., use of regional vs. general anesthesia) might mitigate the incidence of perioperative respiratory events.

The authors’ findings support the growing body of evidence that anesthesia practice in the operating room can have a profound impact on the overall course of care, with substantial economic implications for both patients and hospitals.