Perioperative medicine & outcomes
The association between intraoperative low driving pressure ventilation and perioperative healthcare-associated costs: A retrospective multicenter cohort study
Authors' conclusion
Intraoperative mechanical ventilation targeting low dynamic driving pressures could be a relevant measure to reduce perioperative healthcare-associated costs in high-risk patients.
Study context
- Population
- Adults undergoing GA for non-ambulatory (inpatient and same-day admission) surgery, 2 academic healthcare networks in New York and Massachusetts, US, 2016–2021
- Participants
- 46,715 adults
- Exposure
- Lower vs higher intraoperative dynamic driving pressure
- Outcome
- Direct perioperative healthcare-associated costs (matched with Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS), absolute differences in total costs in US$)
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Change in direct perioperative costs
−0.7 %
95% CI −1.3 to −0.1P = 0.020
Per 5cmH2O reduction in dynamic driving pressure · adjusted
Difference in total perioperative costs
-US$340
95% CI -US$546 to -US$132P = 0.001
Driving pressure <15cmH2O vs Driving pressure ≥15cmH2O
- Median intraoperative dynamic driving pressure 17.2cmH2O (IQR 14.0-21.3cmH2O)
- 17.2
Observational data: associations, not effects.
Further findings
| Outcome | Difference in total perioperative costs (97.5% CI) | P value |
|---|---|---|
| Total perioperative costs, high baseline risk of PRC (SPORC ≥ 7) (subgroup)n = 4059 | -US$1755 (-US$2495 to -US$986) | P < 0.001 |
- Total perioperative costs, high baseline risk of postoperative respiratory complications (PRC) (SPORC ≥ 7) (subgroup) — Proportion mediated by lower risk of PRC (p < 0.001)
- 10.7%
- Total perioperative costs, high baseline risk of PRC (SPORC ≥ 7) (subgroup) — Proportion mediated by lower risk of other major complications (p = 0.015)
- 7.2%
Total perioperative costs, high baseline risk of PRC (SPORC ≥ 7) (subgroup)
- Association limited to patients at high baseline risk of PRC
Original publication
The association between intraoperative low driving pressure ventilation and perioperative healthcare-associated costs: A retrospective multicenter cohort study. J Clin Anesth. Published 26 August 2024. doi:10.
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