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Fast-track eligibility, costs and quality of recovery after intravenous anaesthesia with propofol–remifentanil versus balanced anaesthesia with isoflurane–alfentanil

Published online by Cambridge University Press:  23 December 2004

L. H. J. Eberhart ,
M. Eberspaecher ,
H. Wulf  and
G. Geldner
L. H. J. Eberhart
Affiliation:
Philipps-University of Marburg, Department of Anaesthesia and Intensive Care, Marburg, Germany
M. Eberspaecher
Affiliation:
University of Ulm, Department of Anaesthesiology, Ulm, Germany
H. Wulf
Affiliation:
Philipps-University of Marburg, Department of Anaesthesia and Intensive Care, Marburg, Germany
G. Geldner
Affiliation:
Philipps-University of Marburg, Department of Anaesthesia and Intensive Care, Marburg, Germany
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Abstract

Summary

Background and objective: The randomized, patient- and observer-blinded study was performed in 120 patients undergoing ear, nose and throat surgery to test the hypothesis that intravenous anaesthesia with propofol–remifentanil when compared with a balanced anaesthesia technique using isoflurane–alfentanil improves the speed of recovery, minimizes postoperative side-effects and, thus, leads to an improved quality of recovery without increasing total costs.

Methods: The total costs for each anaesthesia technique were calculated considering drug acquisition costs, personnel costs for the additional time spent in the operating room and the postanaesthesia care unit until fast-tracking eligibility, and the costs to treat the side-effects during and after operation.

Results: The times from the end of surgery to tracheal extubation and the time until leaving the operating room were not different between the two groups. However, more patients receiving intravenous anaesthesia (80 versus 49%) were eligible for fast tracking and thus could bypass the recovery room. This was associated with an average cost saving of €6.00 per patient. However, intravenous anaesthesia was associated with higher total costs (€89 versus €78) mainly because of higher acquisition costs of the anaesthetics (€34.60 versus €16.50). There was no difference in the quality of recovery as measured by a Quality of Recovery score and patient satisfaction between the two groups.

Conclusions: The higher acquisition costs of the intravenous anaesthetics propofol and remifentanil cannot be compensated for by improved speed of recovery. This anaesthesia technique is more cost intensive than balanced anaesthesia using isoflurane and alfentanil.

Keywords

ANAESTHESIA, GENERAL, alfentanil, isoflurane, propofol, remifentanilANAESTHESIA RECOVERY PERIODCOST AND COST ANALYSISECONOMICS, PHARMACEUTICAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 2 , February 2004 , pp. 107 - 114
Copyright
2004 European Society of Anaesthesiology

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References

White PF, Song D. New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete's scoring system. Anesth Analg 1999; 88: 1069–1072.Google Scholar
Song D, Chung F. Fast-tracking in ambulatory anesthesia. Can J Anaesth 2001; 48: 622–625.Google Scholar
Crozier TA, Kettler D. Cost effectiveness of general anaesthesia: inhalation vs. i.v. Br J Anaesth 1999; 83: 547–549.Google Scholar
Eberhart LHJ, Greiner S, Geldner G, Wulf H. Patientenbeurteilung der postoperativen Erholung. Eine Validierung des QoR-Scores an 577 Patienten. Anaesthesist 2002; 51: 463–466.Google Scholar
Myles PS, Hunt JO, Nightingale CE, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg 1999; 88: 83–90.Google Scholar
Fung D, Cohen MM. Measuring patient satisfaction with anesthesia care: a review of current methodology. Anesth Analg 1998; 87: 1089–1098.Google Scholar
Myles PS, Reeves MD, Anderson H, Weeks AM. Measurement of quality of recovery in 5672 patients after anaesthesia and surgery. Anaesth Intensive Care 2000; 28: 276–280.Google Scholar
Bach A, Bauer M, Geldner G, et al. Erfassung der IST-Kosten der Anästhesieabteilungen in Deutschland. Anästh Intensivmed 2000; 41: 903–909.Google Scholar
Koivuranta M, Läärä E, Snåre L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia 1997; 52: 443–449.Google Scholar
Eberhart LHJ, Högel J, Seeling W, Staack AM, Geldner G, Georgieff M. Evaluation of three risk scores to predict postoperative nausea and vomiting. Acta Anaesthesiol Scand 2000; 44: 480–488.Google Scholar
Heidvall M, Hein A, Davidson S, Jakobsson J. Cost comparison between three different general anaesthetic techniques for elective arthroscopy of the knee. Acta Anaesthesiol Scand 2000; 44: 157–162.Google Scholar
Smith I, Terhoeve PA, Hennart D, et al. A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol. Br J Anaesth 1999; 83: 564–570.Google Scholar
Marais ML, Maber MW, Wetchler BV, Korttila K, Apfelbaum JL. Reduced demands on recovery room resources with propofol (Diprivan) compared to thiopental–isoflurane. Anesthesiol Rev 1989; 16: 29–40.Google Scholar
Suver J, Arikian SR, Doyle JJ, Sweeney SW, Hagan M. Use of anesthesia selection in controlling surgery costs in an HMO hospital. Clin Ther 1995; 17: 561–571.Google Scholar
Epple J, Kubitz J, Schmidt H, et al. Comparative analysis of costs of total intravenous anaesthesia with propofol and remifentanil vs. balanced anaesthesia with isoflurane and fentanyl. Eur J Anaesthesiol 2001; 18: 20–28.Google Scholar