A Study of Post Operation Hypotension Burden Model in Korea Using Hira National Inpatient Sample (HIRA-NIS) Data

OBJECTIVES:

Intraoperative hypotension (IOH) is a common issue for the patients of non-cardiac surgeries but it can increase the risk of side effects and longer ICU stay. This study aims to estimate the economic burden of IOH during non-cardiac surgeries in Korea where no previous literature could be found.

METHODS:

The National Inpatient Sample data from the Health Insurance Review and Assessment Services (HIRA-NIS) for three cohorts (2017, 2018, 2019) were used to estimate the burden of IOH in Korea. For the patients with inpatient surgery claims, a vasopressor use was used as a proxy for IOH group and no use as control group. To reduce confounding, propensity score matching based on nearest neighborhood with caliper 0.005 was used to estimate the burden of IOH in Korea. A simultaneous equations model using a three-stage least square (3SLS) regression analysis was set up to estimate the cost burden of IOH in Korea considering LOS and ICU stay.

RESULTS:

A total of 499,627 in 2017, 512,020 in 2018, and 435,884 patients in 2019 were included in the analysis and the percentage of IOH was 40.25%, 41.35%, and 38.98% respectively. The average total cost of IOH group was higher than the one of control group and the IOH impact per patient was estimated by the 3SLS as $299.77, $384.59, and $819.90 (1 USD = 1,250 KRW), respectively. By multiplying the estimated number of IOH patients each year, burden of IOH was estimated from 11.1~12.5 million USD in 2017, 17.1~19.4 million USD in 2018, and 36.7~42.1 million USD in 2019.

CONCLUSIONS:

This study showed the significant association of IOH with greater disease burden, and the estimated budget impact of IOH in Korea. This result offers meaningful grounds to do further research on the disease burden and cost of IOH.