Association of perioperative hypotension with subsequent greater healthcare resource utilization
dc.contributor.author | Stapelfeldt, Wolf H. | |
dc.contributor.author | Khanna, Ashish K. | |
dc.contributor.author | Shaw, Andrew D. | |
dc.contributor.author | Shenoy, Apeksha V. | |
dc.contributor.author | Hwang, Seungyoung | |
dc.contributor.author | Stevens, Mitali | |
dc.contributor.author | Smischney, Nathan J. | |
dc.contributor.department | Anesthesia, School of Medicine | |
dc.date.accessioned | 2024-07-17T09:28:24Z | |
dc.date.available | 2024-07-17T09:28:24Z | |
dc.date.issued | 2021 | |
dc.description.abstract | Study objective: Determine if perioperative hypotension, a modifiable risk factor, is associated with increased postoperative healthcare resource utilization (HRU). Design: Retrospective cohort study. Setting: Multicenter using the Optum® electronic health record database. Patients: Patients discharged to the ward after non-cardiac, non-obstetric surgeries between January 1, 2008 and December 31, 2017 with six months of data, before and after the surgical visit. Interventions/exposure: Perioperative hypotension, a binary variable (presence/absence) at an absolute MAP of ≤65-mmHg, measured during surgery and within 48-h after, to dichotomize patients with greater versus lesser hypotensive exposures. Measurements: Short-term HRU defined by postoperative length-of-stay (LOS), discharge to a care facility, and 30-day readmission following surgery discharge. Mid-term HRU (within 6 months post-discharge) quantified via number of outpatient and emergency department (ED) visits, and readmission LOS. Main results: 42,800 distinct patients met study criteria and 37.5% experienced perioperative hypotension. After adjusting for study covariates including patient demographics and comorbidities, patients with perioperative hypotension had: longer LOS (4.01 vs. 3.83 days; LOS ratio, 1.05; 95% CI, 1.04-1.06), higher odds of discharge to a care facility (OR, 1.18; 95% CI, 1.12-1.24; observed rate 22.1% vs. 18.1%) and of 30-day readmission (OR, 1.22; 95% CI, 1.11-1.33; observed rate 6.2% vs. 5.0%) as compared to the non-hypotensive population (all outcomes, p < 0.001). During 6-month follow-up, patients with perioperative hypotension showed significantly greater HRU regarding number of ED visits (0.34 vs. 0.31 visits; visit ratio, 1.10; 95% CI, 1.05-1.15) and readmission LOS (1.06 vs. 0.92 days; LOS ratio, 1.15; 95% CI, 1.07-1.24) but not outpatient visits (10.47 vs. 10.82; visit ratio, 0.97; 95% CI, 0.95-0.99) compared to those without hypotension. There was no difference in HRU during the 6-month period before qualifying surgery. Conclusions: We report a significant association of perioperative hypotension with an increase in HRU, including additional LOS and readmissions, both important contributors to overall medical costs. | |
dc.eprint.version | Final published version | |
dc.identifier.citation | Stapelfeldt WH, Khanna AK, Shaw AD, et al. Association of perioperative hypotension with subsequent greater healthcare resource utilization. J Clin Anesth. 2021;75:110516. doi:10.1016/j.jclinane.2021.110516 | |
dc.identifier.uri | https://hdl.handle.net/1805/42269 | |
dc.language.iso | en_US | |
dc.publisher | Elsevier | |
dc.relation.isversionof | 10.1016/j.jclinane.2021.110516 | |
dc.relation.journal | Journal of Clinical Anesthesia | |
dc.rights | Attribution 4.0 International | en |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0 | |
dc.source | Publisher | |
dc.subject | Emergency department visit | |
dc.subject | Healthcare resource utilization | |
dc.subject | Length of stay | |
dc.subject | Non-cardiac surgery | |
dc.subject | Outpatient visit | |
dc.subject | Perioperative hypotension | |
dc.title | Association of perioperative hypotension with subsequent greater healthcare resource utilization | |
dc.type | Article |