Anesth Analg 2004;98:708-713
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000096040.02725.74
PAIN MEDICINE
Cost Drivers in Patient-Controlled Epidural Analgesia for Postoperative Pain Management After Major Surgery
Martin Schuster, MD, MA,
André Gottschalk, MD,
Marc Freitag, MD, and
Thomas Standl, MD Section Editor
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Address correspondence and reprint requests to Martin Schuster, MD, MA, Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Address e-mail to m.schuster{at}uke.uni-hamburg.de
In this retrospective study, we determined efficiency, treatment length, and resource use for postoperative pain management with patient-controlled epidural analgesia (PCEA) in 350 consecutive patients undergoing major abdominal, thoracic, gynecological, or orthopedic surgery. Average pain scores on a visual analog scale were 16 ± 23 and 9 ± 16 (visual analog scale range, 0 to 100) on postoperative Days 1 and 3, respectively, and were similar among groups. The treatment length was 4.9 ± 2.2 days in general surgical, 5.2 ± 3.1 days in gynecological, and 4.5 ± 2.8 days in orthopedic patients. The total volumes of the mixture of local anesthetic and opioid received epidurally were 707 ± 507 mL, 770 ± 576 mL, and 593 ± 456 mL in the general surgical, gynecological, and orthopedic groups, respectively. The average total costs for all groups for the full treatment course with PCEA were
447 ±
218 per case (
1 equals approximately US$1). Fifty-one percent of these costs were staff costs, 20% were costs for the applied drugs, 15% were costs for PCEA pumps and pump material, and 13% were costs for the initial catheter insertion. In the light of these costs and the availability of less costly alternatives, measurements for cost containment by using PCEA are recommended. Because treatment length is the main cost driver both for drug and staff costs, close monitoring of treatment length and a predefined migration path to alternative techniques after PCEA should be considered.
IMPLICATIONS: Patient-controlled epidural analgesia is increasingly used as first-line treatment for postoperative pain management. In this study, costs and cost drivers are analyzed for the first time for this new technique, based on 350 cases of pain therapy after major surgery in a university hospital.
This article has been cited by other articles:
|
|
|
|
 
F. Bonnet and E. Marret
Influence of anaesthetic and analgesic techniques on outcome after surgery
Br. J. Anaesth.,
July 1, 2005;
95(1):
52 - 58.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Schuster, T. Standl, H. Reissmann, L. Kuntz, and J. S. am Esch
Reduction of Anesthesia Process Times After the Introduction of an Internal Transfer Pricing System for Anesthesia Services
Anesth. Analg.,
July 1, 2005;
101(1):
187 - 194.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. I. Fernandez, A. E. Martin-Ucar, H.D. Lee, K. J. West, R. Wyatt, and D. A. Waller
Does a thoracic epidural confer any additional benefit following video-assisted thoracoscopic pleurectomy for primary spontaneous pneumothorax?
Eur. J. Cardiothorac. Surg.,
April 1, 2005;
27(4):
671 - 674.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Schuster, A. Gottschalk, J. Berger, and T. Standl
A Retrospective Comparison of Costs for Regional and General Anesthesia Techniques
Anesth. Analg.,
March 1, 2005;
100(3):
786 - 794.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
