OBJECTIVES :

Intraoperative hypotension (IOH) is increasingly associated with higher risk of mortality and other major clinical events. Recent studies have demonstrated this relationship considering diverse definitions of IOH severity. However, the impact on the Spanish Healthcare System remains unclear. This study wants to assess the economic burden of adverse clinical outcomes (ACOs) associated with IOH in high-risk non-cardiac surgery in Spain.

METHODS

RAE-CMBD, a Spanish Ministry of Health’s database using ICD-10 codification, was used to extract the number of non-cardiac high-risk surgical procedures performed each year (2016-2019) in Spain, as well as the costs of managing ACOs (using DRGs). Data from large cohort studies with different severity profiles were used to estimate the risk of ACOs (i.e.) based on IOH severity (<65mmHg). The number of surgeries was distributed between thresholds of severity or duration of hypotension according to the population of the studies to estimate number of ACOs. Unitary cost (€,2021) from national tariffs DRGs were considered in a conservative approach.

RESULTS

186,648 (2016) and 203,395 (2019) non-cardiac surgical procedures were categorized as of high-risk, with an annual increase of 2.17%. Estimated IOH incidence was 19%, with patients suffering a mean 4,354 ACOs (including 1,085 deaths at 90 days) with a mean cost of 21.8 million euros. In another analysis using estimates from another publication with an IOH incidence of 72%, patients suffered a mean 13,909 ACOs (only considering acute kidney injury and myocardial injury), with a mean cost of 56.4 million euros.

CONCLUSIONS

Undoubtedly, ACOs associated with IOH in high-risk surgery entail a high economic burden for the Spanish healthcare system with a growing cost, due to the increase of high-risk procedures. Innovations and protocols targeting IOH’s optimization are warranted to minimize this burden.