Association of reintubation and hospital costs and its modification by postoperative surveillance: A multicenter retrospective cohort study

• Published in: Journal of clinical anesthesia Vol. 91; no. C; p. 111264
• Main Authors: Rudolph, Maíra I., Azimaraghi, Omid, Salloum, Elie, Wachtendorf, Luca J., Suleiman, Aiman, Kammerer, Tobias, Schaefer, Maximilian S., Eikermann, Matthias, Kiyatkin, Michael E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2023; Elsevier Limited
• Subjects: Adult; Anesthesia, General; Cohort analysis; Comorbidity; Confidence intervals; Confounding (Statistics); Cost estimates; Extubation; General anesthesia; Generalized linear models; Health care expenditures; Health services utilization; Heart surgery; Hospital Costs; Humans; Intensive care; Intubation; Length of Stay; Medical personnel; Missing data; PACU; Patients; Postoperative Period; Postoperative reintubation; Recovery Room; Respiratory failure; Retrospective Studies; Surveillance; Variables; United States > US; Postoperative reintubation; Hospital costs; Surveillance; PACU
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2023.111264

We estimated hospital costs associated with postoperative reintubation and tested the hypothesis that prolonged surveillance in the post-anesthesia care unit (PACU) modifies the hospital costs of reintubation. Retrospective observational research study. Two tertiary care academic healthcare networks in the Bronx, New York and Boston, Massachusetts, USA. 68,125 adult non-cardiac surgical patients undergoing general anesthesia between 2016 and 2021. The exposure variable was unplanned reintubation within 7 days of surgery. The primary outcome was direct hospital costs associated with patient care related activities. We used a multivariable generalized linear model based on log-transformed costs data, adjusting for pre- and intraoperative confounders. We matched our data with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS). In the key secondary analysis, we examined if prolonged postoperative surveillance, defined as PACU utilization (≥4 h) modifies the association between reintubation and costs of care. 1759 (2.6%) of patients were re-intubated within 7 days after surgery. Reintubation was associated with higher direct hospital costs (adjusted model estimate 2.05; 95% CI: 2.00–2.10) relative to no reintubation. In the HCUP-NIS matched cohort, the adjusted absolute difference (ADadj) in costs amounted to US$ 18,837 (95% CI: 17,921–19,777). The association was modified by the duration of PACU surveillance (p-for-interaction <0.001). In patients with a shorter PACU length of stay, reintubation occurred later (median of 2 days; IQR 1, 5) versus 1 days (IQR 0, 2; p < .001), and was associated with magnified effects on hospital costs compared to patients who stayed in the PACU longer (ADadj of US$ 23,444, 95% CI: 21,217–25,799 versus ADadj of US$ 17,615, 95% CI: 16,350–18,926; p < .001). Postoperative reintubation is associated with 2-fold higher hospital costs. Prolonged surveillance in the recovery room mitigated this effect. The cost-saving effect of longer PACU length of stay was likely driven by earlier reintubation in patients who needed this intervention. •Postoperative reintubation increases hospital costs of care by twofold.•Longer surveillance in the post-anesthesia care unit help mitigate these costs.•Prolonged surveillance may help identify patients who need reintubation.