OBJECTIVES : Optimizing pain management during surgery is a major challenge. Personalizing analgesia to provide optimal pain control may reduce the risk of patient harm and facilitate a smooth procedure with improved recovery. The nociception level index (NOL) measures the patients’ pain response (nociception) when under general anesthesia. Here we assess the cost-benefit of NOL from a provider perspective.

METHODS : Device-specific clinical study data were supplemented with costs and outcomes data identified via a structured, PubMed review. Outcomes of interest were intraoperative hypotension (IOH), opioid use, and postoperative myocardial injury (MI) and acute kidney injury (AKI). The population was 1,000 patients undergoing non-cardiac, surgical procedures requiring general anesthesia. An Excel^®-based health-economic, decision-tree model estimated the incremental cost of hospital ownership, change in adverse patient outcomes, and time to return on investment (ROI). Costs are reported in 2019 USD ($). Variance was assessed via the interquartile range (IQR) following 200 simulations.

RESULTS : A large retrospective analysis found that 3.1% and 5.6% of US patients developed MI and AKI, respectively. Overall, 33.4% of patients had intraoperative hypotension. In 1,000 patients from this group, personalized analgesia management is expected to reduce remifentanil use by 347 μg per patient and prevent 243 patients from experiencing IOH. Model estimates predict this could reduce adverse outcomes by 20 events (IQR 16-23). This was made up of 8 MIs and 12 AKIs, saving 83 (IQR 65-94) inpatient days. Assuming all purchase costs for monitoring for the year were upfront, ROI should be achieved in 2-5 months. After 12 months, hospitals are expected to have saved $325,980 ($218,000 to $417,000).

CONCLUSIONS : Clinical outcomes data suggest that personalized and optimized analgesia management can prevent intraoperative adverse events and improve outcomes. Not only beneficial to patients, improved outcomes will likely reduce the burden of care on hospitals.