The Cost of Patient Suffering
Adverse events caused by opioids and gas anesthesia can damage both profitability and reputation.
Pain
In 2000, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) recognized pain as “The 5th Vital Sign.” The old adage that pain is simply part of the healing process is no longer acceptable.
Considering that nearly 4 out of 5 patients undergoing surgery experience some degree of post-surgical pain, 26 the costs to treat poorly managed pain can significantly impact the bottom line. Persistent pain may hinder the return of normal respiratory and gastrointestinal functions, impair wound healing, delay rehabilitation and prolong hospitalization. These factors reduce patient wellbeing and increase costs.16
PONV (Post Operative Nausea and Vomiting)
The cost of one episode of PONV is profound. Each episode of emesis in the post-anesthesia care unit (PACU) increases the length of stay by 20 minutes. 27 Between labor and patient flow, just ten episodes per month can cost up to $25,000 per year.28 Most of these costs (70-80%) come from nursing labor during prolonged PACU stays caused by persistent PONV or the adverse effects of antiemetics.27
DVT (Deep Vein Thrombosis)
Patients undergoing surgery in general, and especially lower extremity orthopedic procedures, are at high risk to develop DVT. It has been reported that the cost associated with a thromboembolic event averages $10,804 for a DVT and $16,644 for a pulmonary embolism (PE). 29 The CDC includes reduction in DVT as one of ten major factors for reducing adverse events.
Hypothermia
During general anesthesia, normal central thermoregulatory responses are inhibited, causing a reduction in sympathetic tone and redistribution of body heat from the core to the periphery. The resulting hypothermia can lead to a higher incidence of cardiovascular complications, such as myocardial ischemia or arrhythmia.
Hypothermic patients are also at increased risk for bleeding, wound infections and delayed wound healing. These adverse events can add between $2,500 and $7,500 per surgical patient to hospitalization costs, even with hypothermia only 1.5 degrees less than normal.30
Respiratory Depression
Respiratory depressive effects (although the least commonly reported of opioid-related ADEs) make up the majority of severe opioid adverse outcome reports. A comprehensive literature review conducted between 1990 and 2004 found that 0.19% to 5.2% of patients using IVPCA experience opioid-induced respiratory depression.16 Patients with this condition may constitute a prominent subgroup in the 350,000 to 750,000 patients who annually suffer in-hospital cardiac arrest.
Ileus
Gastrointestinal ADEs are considered the most common and debilitating adverse effect associated with opioid use. Post-operative paralytic ileus (PI) may last for days and prolong hospital stay and convalescence.18 Eighty percent of 2,685,854 patients who received opioids during their hospital stay experienced significant gastrointestinal ADEs. An analysis of a large national database revealed that patients with code post-operative ileus experienced an increase in LOS (additional 6 days) and higher healthcare costs (additional $9,417).16
Medication Errors
Almost half of all deaths attributed to medication errors involve opiates.23 The complexities associated with opioid delivery have made them a significant source of preventable medication errors. Specifically, nearly 4.5% of the 13 million patients receiving IVPCA each year in the United States experience device-related errors that are often costly, time consuming and harmful to patient health.
When considering the average cost per error event, IVPCA translates into $388 million for medication-related errors and $12 million for device-related errors. The combination of the high rate at which IVPCA errors occur and their associated costs underscores the need for safer and less costly approaches to post-operative pain management.16
Post-Operative Functional Level
Patients want to get out of bed and return to work and home sooner. Patients who experience PONV after discharge require more time to get back to normal activities.31 Furthermore, surgeons want their patients to mobilize earlier and start physical therapy sooner.