Perioperative interventions aimed at decreasing costs and improving outcomes have become increasingly popular in recent years. Anesthesiologists are often faced with a choice among different treatment strategies with little data available on the comparative cost-effectiveness. We performed a systematic review of the English language literature between 1980 and 2014 to identify cost-effectiveness analyses of anesthesiology and perioperative medicine interventions. We excluded interventions related to critical care or pediatric anesthesiology, and articles on interventions not normally ordered or performed by anesthesiologists. Of the >5000 costeffectiveness analyses published to date, only 28 were applicable to anesthesiology and perioperative medicine and met inclusion criteria. Multidisciplinary interventions were the most cost-effective overall; 8 of 8 interventions were "dominant" (improved outcomes, reduced cost) or cost-effective, including accelerated, standardized perioperative recovery pathways, and perioperative delirium prevention bundles. Intraoperative measures were dominant in 3 of 5 cases, including spinal anesthesia for benign abdominal hysterectomy. With regard to prevention of perioperative infection, methicillin-resistant Staphylococcus aureus (MRSA) decolonization was dominant or cost-effective in 2 of 2 studies. Three studies assessing various antibiotic prophylaxis regimens had mixed results. Autologous blood donation was not found to be cost-effective in 5 of 7 studies, and intraoperative cell salvage therapy was also not cost-effective in 2 of 2 reports. Overall, there remains a paucity of cost-effectiveness literature in anesthesiology, particularly relating to intraoperative interventions and multidisciplinary perioperative interventions. Based on the available studies, multidisciplinary perioperative optimization interventions such as accelerated, standardized perioperative recovery pathways, and perioperative delirium prevention bundles tended to be most cost-effective. Our review demonstrates that there is a need for more rigorous cost-effective analyses in many areas of anesthesiology and that anesthesiologists should continue to lead collaborative, multidisciplinary efforts in perioperative medicine. Accepted for publication February 9, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Bijan J. Teja, MD, MBA, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. Address e-mail to bijanteja@gmail.com. © 2018 International Anesthesia Research Society
http://ift.tt/2GVbSP2
Αρχειοθήκη ιστολογίου
-
►
2020
(289)
- ► Φεβρουαρίου (28)
-
►
2019
(9071)
- ► Δεκεμβρίου (19)
- ► Σεπτεμβρίου (54)
- ► Φεβρουαρίου (3642)
- ► Ιανουαρίου (3200)
-
▼
2018
(39872)
- ► Δεκεμβρίου (3318)
- ► Σεπτεμβρίου (3683)
-
▼
Μαρτίου
(3597)
-
▼
Μαρ 22
(202)
- Local Anesthetic Injection Speed and Common Perone...
- Case of a fractured human bone fragment as an endo...
- Klippel-Trenaunay-Weber syndrome as a cause of chr...
- Testicular torsion in a patient with Ehlers-Danlos...
- Two cases of hypokalaemic rhabdomyolysis: same but...
- A rare presentation of haematuria: hip prosthesis ...
- Importance of source images of time-of-flight magn...
- Central congenital hypothyroidism caused by matern...
- Tarsal buckle with conjunctival prolapse following...
- Complication of intraprosthetic dislocation of dua...
- Myocarditis secondary to smallpox vaccination
- Parkinsons disease with hypocalcaemia: adult prese...
- Diffusion-weighted imaging is helpful in the accur...
- Effect of Splenectomy on Serum Cytokine Profiles i...
- A brave new world
- Intracell Heat Shock Protein 70 Expression and Nas...
- Post Parotidectomy Quality of Life in Patients wit...
- The Journal of Dermatology, Ahead of Print.
- The Journal of Dermatology, Ahead of Print.
- Intracell Heat Shock Protein 70 Expression and Nas...
- Post Parotidectomy Quality of Life in Patients wit...
- Biologicals in der Rhinologie – Individualisierte ...
- Molekulares Verstehen des Hörens – Was ändert sich...
- Das Mikrobiom – die unplanbare Größe zukünftiger T...
- HPV – Das andere Kopf-Hals-Karzinom
- Radiomics: Big Data statt Biopsie in der Zukunft?
- Robotische Chirurgie – operiert der Roboter?
- Regeneration – eine neue therapeutische Dimension ...
- Editorial Referateband 2018
- Immuntherapie – Die neue Ära in der Onkologie
- Safety of a two-day ultra-rush immunotherapy in ve...
- From the pages of allergywatch recent advances in ...
- Head &Neck, Ahead of Print.
- Head &Neck, Ahead of Print.
- Head &Neck, Ahead of Print.
- Radioguided Surgery in Primary Hyperparathyroidism...
- Head &Neck, Ahead of Print.
- Head &Neck, Ahead of Print.
- Thyroid® High-Impact Articles
- Discrepancy between clinical and pathological neck...
- Impact of Total Laryngectomy on Return to Work
- Salivary Pepsin Test: Useful and Simple Tool for t...
- Correlation Between Measures of Perceptual Assessm...
- Cleft Lip and Palate Subjects Prevalence of Abnorm...
- Efficacy of the Myofascial Pectoralis Major Flap i...
- Cochleotoxicity monitoring protocol
- Recurrent Respiratory Papillomatosis With Lung and...
- Metastasis of Gallbladder Adenocarcinoma to the Sk...
- Castleman's Disease in the Paediatric Neck
- Arteria lusoria: A rare cause of tracheal compression
- Plummer Vinson syndrome
- Comments on the Assessment of Nasal Obstruction Wi...
- A 10 Point Plan to Demonstrate the Value of Dermat...
- Reply to DR. De Cassai et al.
- Australasian Journal of Dermatology, Ahead of Print.
- Asthma Guidelines from the National Asthma Educati...
- Ataxia Telangiectasia: A Rare Neurodegenerative Di...
- Ataxia-Telangiectasia Clinical and Laboratory Feat...
- 2017 Acknowledgment of Reviewers
- Australasian Journal of Dermatology, Ahead of Print.
- Procedures for central auditory processing screeni...
- Predicting complications of major head and neck on...
- Asthma Guidelines from the National Asthma Educati...
- Ataxia Telangiectasia: A Rare Neurodegenerative Di...
- Ataxia-Telangiectasia Clinical and Laboratory Feat...
- 2017 Acknowledgment of Reviewers
- What parents are reading about laryngomalacia: Qua...
- Auditory function and motor proficiency in type 1 ...
- Nasal saline irrigation in pediatric rhinosinusiti...
- Development and validation of a quality of life in...
- A functional and anatomical comparison between two...
- Three-dimensional development of the upper dental ...
- Diagnosis and management of pediatric sinusitis: A...
- Effect of early correction of nasal septal deformi...
- Obstructive sleep apnea syndrome and growth failure
- Open resection and laryngotracheal reconstruction ...
- Surgical treatment for chronic cervical lymphadeni...
- Early experience with high-flow nasal oxygen thera...
- Systematic review/meta-analysis comparing successf...
- Trends in the management of secondary post-tonsill...
- Autosomal dominant stapes fixation, syndactyly, an...
- Swallowing outcomes in children after slide trache...
- Primary augmentation pharyngoplasty with calcium h...
- Nasal erosion as an uncommon sign of child abuse
- Clinically recorded cortical auditory evoked poten...
- Pediatric Otolaryngology: Practical Clinical Manag...
- Wheel Spokes Technique for Endothelial Keratoplast...
- Adult Coats Disease Presenting as Subfoveal Nodule
- Triamcinolone Acetonide-Assisted Descemetectomy fo...
- Intraoperative Adjunctive Mitomycin C and Cryother...
- Secondary Angle Closure due to Crystalline Lens Di...
- Hypercoagulability, Obstructive Sleep Apnea, and P...
- Hypercoagulability, Obstructive Sleep Apnea, and P...
- Self-reported Hearing Difficulty and Risk of Accid...
- A Rare Cause of Oropharyngeal and Supraglottic Air...
- Economic Interdependencies and Political Conflict:...
- APOBEC mutagenesis in drug resistance and immune e...
- Assessing the acceptability of incentivising HPV v...
- Inhibition of sodium/hydrogen exchanger 3 in the g...
- NODDI-DTI: estimating neurite orientation and disp...
-
▼
Μαρ 22
(202)
- ► Φεβρουαρίου (2693)
- ► Ιανουαρίου (3198)
-
►
2017
(41099)
- ► Δεκεμβρίου (3127)
- ► Σεπτεμβρίου (2173)
-
►
2016
(13807)
- ► Δεκεμβρίου (700)
- ► Σεπτεμβρίου (600)
- ► Φεβρουαρίου (1350)
- ► Ιανουαρίου (1400)
-
►
2015
(1500)
- ► Δεκεμβρίου (1450)
Ετικέτες
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου