AUTHOR=Song Shujia , Pei Lijian , Chen Hongda , Zhang Yuelun , Sun Chen , Yi Jie , Huang Yuguang 

TITLE=Analysis of hospital and payer costs of care: aggressive warming versus routine warming in abdominal major surgery

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1256254

DOI=10.3389/fpubh.2023.1256254

ISSN=2296-2565

ABSTRACT=Background: Hypothermia is common and active warming is recommended in major surgery. The potential effect of aggressive warming to a core temperature target to 37℃ on hospitals and payer costs is poorly understood.In this sub-analysis of the PROTECT trial (clinicaltrials.gov, NCT03111875), we included patients who underwent radical procedures of colorectal cancer and were randomly assigned to aggressive warming or routine warming. Perioperative outcomes, operation room (OR) scheduling process, and internal cost accounting data from China Statistical yearbook (2022), price list of medical and health institutions in Beijing were examined. A discrete event simulation (DES) model was established to compare OR efficiency using aggressive warming or routine warming in 3 months. We report base-case net costs and sensitivity analyses of intraoperative aggressive warming compared with routine warming. Costs were in 2022 US dollars (USD).Results: Data from 309 patients were finally analyzed, aggressive warming group comprised 161 patients and routine warming group comprised 148 patients. Compared to routine warming, there were no difference in the incidence of postoperative complications and total hospitalization costs of patients with aggressive warming. The potential benefit of aggressive warming was in the reduced extubation time (7.96 ± 4.33min vs 10.33 ± 5.87 min, P <0.001), lower incidence of prolonged extubation (5.6% vs 13.9%, P=0.017) and decreased staff costs. In the DES model, there is no add on or cancellation of operations performed within 3 months. The net costs of hospital related to aggressive warming were higher than those related to routine warming in one operation (138.11 USD vs 72.34 USD). Aggressive warming will have economic benefit when the OR staff cost is higher than 2.37 USD/min/person, or the cost of disposable forced-air warming (FAW) is less than 12.88 USD/piece. Conclusions: Despite improving OR efficiency, the economic benefits of aggressive warming are influenced by staff costs and the cost of FAW, which vary from different regions and countries.