Potential return on investment for implementation of perioperative goal-directed fluid therapy in major surgery: a nationwide database study

Background: Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden. A recent meta-analysis showed a 17-29 % decrease in postoperative morbidity with goal-directed fluid therapy. Our objective was to estimate the potential economic impact of perioperative goal-directed fluid therapy. Methods: We studied 204,680 adult patients from 541 US hospitals who had a major non-cardiac surgical procedure between January 2011 and June 2013. Hospital costs (including 30-day readmission costs) in patients with and without complications were extracted from the Premier Inc. research database, and potential cost-savings associated with a 17-29 % decrease in postoperative morbidity were estimated. Results: A total of 76,807 patients developed one or more postsurgical complications (morbidity rate 37.5 %). In patients with and without complications, hospital costs were US$ 27,607 +/- 32,788 and US$ 15,783 +/- 12,282 (p < 0.0001), respectively. Morbidity rate was anticipated to decrease to 26.6-31.1 % with goal-directed fluid therapy, yielding potential gross cost-savings of US$ 153-263 million for the study period, US$ 61-105 million per year, or US$ 754-1286 per patient. Potential savings per patient were highly variable from one surgical procedure to the other, ranging from US$ 354-604 for femur and hip-fracture repair to US$ 3515-5996 for esophagectomies. When taking into account the volume of procedures, the total potential savings per year were the most significant (US$ 32-55 million) for colectomies. Conclusions: Postsurgical complications occurred in more than one third of our study population and had a dramatic impact on hospital costs. With goal-directed fluid therapy, potential cost-savings per patient were US$ 754-1286. The highest cost-savings per year were observed for colectomies. These projections should help hospitals estimate the return on investment when considering the implementation of goal-directed fluid therapy.