Real-World Assessment of the Impact of Intraoperative Hypotension on Healthcare Resource Utilization (HCRU) After Elective Non-Cardiac Surgery
Author(s)
Wael Saasouh, MD1, XUAN ZHANG, MD PhD2, Ian Weimer, MS3, Brent Hale, RPh4, Desirée Chappell, CRNA5;
1Wayne State University School of Medicine, Detroit, MI, USA, 2Boston Strategic Partners Inc, Boston, MA, USA, 3Boston Strategic Partners, Inc., Boston, MA, USA, 4BD, Advanced Patient Monitoring, Franklin Lakes, NJ, USA, 5NorthStar Anesthesia, Irving, TX, USA
1Wayne State University School of Medicine, Detroit, MI, USA, 2Boston Strategic Partners Inc, Boston, MA, USA, 3Boston Strategic Partners, Inc., Boston, MA, USA, 4BD, Advanced Patient Monitoring, Franklin Lakes, NJ, USA, 5NorthStar Anesthesia, Irving, TX, USA
Presentation Documents
OBJECTIVES: Intraoperative hypotension (IOH) may lead to serious adverse outcomes including acute kidney injury, myocardial injury after non-cardiac surgery, and death. This study compares HCRU during the postoperative 90 days among patients undergoing non-cardiac procedures with or without IOH.
METHODS: The Optum Market Clarity Linked Electronic Health Record with Claims dataset was utilized to identify adults undergoing elective moderate- to high-risk (ASA physical status 2-4) non-cardiac/non-cesarian procedures 2010-2023 (one procedure per patient). IOH was defined as mean arterial pressure (MAP) <65 mmHg for a cumulative 15 minutes. HCRU during the postoperative 30-, 60-, and 90-day periods was defined as days with a claim for inpatient, outpatient, emergency room, or other service visit. HCRU was described descriptively, overall mean HCRU was modeled to determine significance via multivariable generalized linear modeling with a gamma distribution and log link. Multivariable analysis adjusted for patient demographics and administrative factors.
RESULTS: The study cohort comprised 10,850 patients, of whom 2,038 (18.8%) experienced IOH. Highest rate of IOH was seen in ASA Class 2 (20.7%), followed by 3 (18.3%), and 4 (14.6%). Nearly all patients had HCRU over the 90-day follow-up, with 82.2% (n=8,920) having outpatient HCRU and 48.1% (n=5,220), inpatient HCRU. For both the Overall cohort and ASA subgroups, patients with IOH utilized more healthcare resources than patients without IOH at all time points. After adjustment, overall mean HCRU was higher for IOH vs. no IOH by 6.8% at 30d (p=0.009), 5.9% at 60d (p=0.024), and 6.4% at 90d (p=0.015).
CONCLUSIONS: IOH is a prevalent intermediate outcome for patients undergoing elective non-cardiac surgery, having clinical and economic impact, including increased HCRU. This increase persists across ASA classes, with ASA class 2 patients experiencing particularly high rates of IOH and HCRU. Implementing technologies and strategies to prevent IOH is crucial for efficient use of healthcare resources, regardless of perceived comorbidities.
METHODS: The Optum Market Clarity Linked Electronic Health Record with Claims dataset was utilized to identify adults undergoing elective moderate- to high-risk (ASA physical status 2-4) non-cardiac/non-cesarian procedures 2010-2023 (one procedure per patient). IOH was defined as mean arterial pressure (MAP) <65 mmHg for a cumulative 15 minutes. HCRU during the postoperative 30-, 60-, and 90-day periods was defined as days with a claim for inpatient, outpatient, emergency room, or other service visit. HCRU was described descriptively, overall mean HCRU was modeled to determine significance via multivariable generalized linear modeling with a gamma distribution and log link. Multivariable analysis adjusted for patient demographics and administrative factors.
RESULTS: The study cohort comprised 10,850 patients, of whom 2,038 (18.8%) experienced IOH. Highest rate of IOH was seen in ASA Class 2 (20.7%), followed by 3 (18.3%), and 4 (14.6%). Nearly all patients had HCRU over the 90-day follow-up, with 82.2% (n=8,920) having outpatient HCRU and 48.1% (n=5,220), inpatient HCRU. For both the Overall cohort and ASA subgroups, patients with IOH utilized more healthcare resources than patients without IOH at all time points. After adjustment, overall mean HCRU was higher for IOH vs. no IOH by 6.8% at 30d (p=0.009), 5.9% at 60d (p=0.024), and 6.4% at 90d (p=0.015).
CONCLUSIONS: IOH is a prevalent intermediate outcome for patients undergoing elective non-cardiac surgery, having clinical and economic impact, including increased HCRU. This increase persists across ASA classes, with ASA class 2 patients experiencing particularly high rates of IOH and HCRU. Implementing technologies and strategies to prevent IOH is crucial for efficient use of healthcare resources, regardless of perceived comorbidities.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE99
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), STA: Surgery