The Influence of an Anesthetic Regimen on Patient-Care, Outcome, and Hospital Charges

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The effects of the anesthetic regimen on patient care, outcome, and hospital charges were studied in 86 morbidly obese patients who underwent gastric reservoir reduction at two hospitals (A and B) in the Detroit Medical Center. At Hospital A, postoperative ventilation was routinely planned in 36 patients who received two intravenous lines, an arterial ine, and a Foley catheter. At Hospital B, postoperative ventilation was not routinely planned for in 50 patients who received one intravenous line and no Foley catheter or arterial line. For anesthesia, Hospital A routinely used isoflurane (0.98%) and N2O (53.0%) with little fentanyl (0.7 mg in 26 patients). Muscle relaxation with pancuronium (13.2 mg) was reversed in only five patients. In contrast, Hospital B patients used little isoflurane (0.4% in 14 patients),* more N2O (64.0%),* more fentanyl (1.3 mg),* and less pancuronium (9.7 mg)*; reversal with naloxone and pyridostigmine was routine. The operating room time was longer in Hospital A patients (5.0 vs 4.6 hours),* and they received significantly more intravenous fluids (6.2L vs 3.2L).* Routine postoperative ventilation in Hospital A patients led to a 46.5 hour intensive care unit stay and a 9.7 day postoperative stay. In contrast, routine anesthetic reversal allowed operating room extubation, patient self-transfer to the stretcher, and ambulation on the day of surgery in Hospital B where patients had a 1.7 hour recovery room stay and a 9.6 day postoperative stay. Total hospital charges in Hospital A patients averaged $14,524.00 due to the increased cost of the intensive care unit ($2,094.00) and support services versus $7,580.00* in Hospital B patients. All 86 patients survived. Routine operating room and postoperative invasive monitoring and postoperative ventilation in an intensive care unit setting significantly increases hospital charges and is not required for quality care, either medically or legally, of gastric reservoir reduction patients.

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