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October 4, 2021Journal of Patient SafetyOpen Access

A Monte Carlo Simulation to Estimate the Additional Cost Associated With Adverse Medication Events Leading to Intraoperative Hypotension and/or Hypertension in the United States

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Why the study?

Intraoperative hypertension and hypotension are common and often related to adverse medication events, but the annual additional costs to the U.S. healthcare system were unknown.

Population

277 operations in randomly selected operating rooms

Comparison

Adverse medication events associated with intraoperative hypotension and hypertension

Design

Observational study with systematic literature reviews and Monte Carlo simulation

Discussion

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Overview

Should not yet change practice; leaves open whether preventing medication-related BP events would reduce AKI, MI, or national costs.

Structured PICO

P
Population
Patients undergoing noncardiac surgery in the United States (observational cohort n=277 operations; national estimate based on 19.8 million adult surgical procedures).
I
Intervention
Adverse medication events (AMEs) leading to clinically significant intraoperative hypotension (MAP <55 mmHg for >6 minutes or >30% drop from baseline) and/or hypertension (MAP >150 mmHg or SBP >200 mmHg).
O
Outcome
Annual additional fully allocated costs to the U.S. healthcare system related to AMEs associated with clinically significant intraoperative hypertension and hypotension.

Adverse medication events causing intraoperative blood pressure fluctuations are estimated to cost the US healthcare system $1.7 billion annually, highlighting a major financial incentive for perioperative safety improvements.

Limitations

  • Papers studied for inputs are retrospective analyses reporting associations, not causations
  • Potential for unknown confounding factors in the literature estimates
  • Cost estimate for myocardial injury based on post-CABG MI rather than noncardiac injury
  • Stroke incidence after hypertension based on 1-year cumulative outcome rather than immediate post-event period

Cite This Study

A 2021 study studied this question.

synapsesocial.com/papers/6a7fa2b6812a481b9a5f257dhttps://doi.org/10.1097/pts.0000000000000926
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The association of hypotension during non‐cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis2018 · 262 citations
  2. 2Crisis management during anaesthesia: hypotension2005 · 48 citations
  3. 3Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery2017 · 948 citations
  4. 4Intraoperative Blood Pressure What Patterns Identify Patients at Risk for Postoperative Complications?1990 · 138 citations
  5. 5Perioperative Stroke and Associated Mortality after Noncardiac, Nonneurologic Surgery2011 · 348 citations