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Preoperative Spirometry and Laparotomy : Blowing Away Dollars

Louis A. De Nino; Valerie A. Lawrence; Ellen C. Averyt; Susan G. Hilsenbeck; Rahul Dhanda; Carey P. Page
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Affiliations: From South Texas Veterans Healthcare System, Audie L. Murphy Division: Geriatric Research, Education and Clinical Center, The University of Texas Health Science Center at San Antonio, San Antonio,  From the Division of General Medicine, The University of Texas Health Science Center at San Antonio; and the Department of Medicine, Division of General Medicine, San Antonio,  From the Department of Medicine, Division of Oncology, San Antonio,  From the Department of Medicine, Division of Geriatrics, San Antonio,  From the Surgery Service, The University of Texas Health Science Center at San Antonio; and the Department of Surgery, San Antonio

Affiliations: From South Texas Veterans Healthcare System, Audie L. Murphy Division: Geriatric Research, Education and Clinical Center, The University of Texas Health Science Center at San Antonio, San Antonio,  From the Division of General Medicine, The University of Texas Health Science Center at San Antonio; and the Department of Medicine, Division of General Medicine, San Antonio,  From the Department of Medicine, Division of Oncology, San Antonio,  From the Department of Medicine, Division of Geriatrics, San Antonio,  From the Surgery Service, The University of Texas Health Science Center at San Antonio; and the Department of Surgery, San Antonio

Affiliations: From South Texas Veterans Healthcare System, Audie L. Murphy Division: Geriatric Research, Education and Clinical Center, The University of Texas Health Science Center at San Antonio, San Antonio,  From the Division of General Medicine, The University of Texas Health Science Center at San Antonio; and the Department of Medicine, Division of General Medicine, San Antonio,  From the Department of Medicine, Division of Oncology, San Antonio,  From the Department of Medicine, Division of Geriatrics, San Antonio,  From the Surgery Service, The University of Texas Health Science Center at San Antonio; and the Department of Surgery, San Antonio

Affiliations: From South Texas Veterans Healthcare System, Audie L. Murphy Division: Geriatric Research, Education and Clinical Center, The University of Texas Health Science Center at San Antonio, San Antonio,  From the Division of General Medicine, The University of Texas Health Science Center at San Antonio; and the Department of Medicine, Division of General Medicine, San Antonio,  From the Department of Medicine, Division of Oncology, San Antonio,  From the Department of Medicine, Division of Geriatrics, San Antonio,  From the Surgery Service, The University of Texas Health Science Center at San Antonio; and the Department of Surgery, San Antonio

Affiliations: From South Texas Veterans Healthcare System, Audie L. Murphy Division: Geriatric Research, Education and Clinical Center, The University of Texas Health Science Center at San Antonio, San Antonio,  From the Division of General Medicine, The University of Texas Health Science Center at San Antonio; and the Department of Medicine, Division of General Medicine, San Antonio,  From the Department of Medicine, Division of Oncology, San Antonio,  From the Department of Medicine, Division of Geriatrics, San Antonio,  From the Surgery Service, The University of Texas Health Science Center at San Antonio; and the Department of Surgery, San Antonio


1997 by the American College of Chest Physicians


Chest. 1997;111(6):1536-1541. doi:10.1378/chest.111.6.1536
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Published online

Abstract

Study Objective: Increasing evidence indicates that routine preoperative diagnostic spirometry (pulmonary function tests [PFTs]) before elective abdominal surgery does not predict individual risk of postoperative pulmonary complications and is overutilized. This economic evaluation estimates potential savings from reduced use of preoperative PFTs.

Design: Analyses of (1) real costs (resource consumption to perform tests) and (2) reimbursements (expenditures for charges) by third-party payers.

Setting: University-affiliated public and Veterans Affairs hospitals.

Patients: Adults undergoing elective abdominal operations.

Measurements and results: Average real cost of PFTs was $19.07 (95% confidence interval [CI], $18.53 to $19.61), based on a time and motion study. Average reimbursement expenditure by third-party payers for PFTs was $85 (range, $33 to $150; 95% CI, $68 to $103), based on Medicare payment of $52 and a survey of nine urban US hospitals with a spectrum of bed sizes and teaching status. Estimates from published literature included the following: (1) annual number of major abdominal operations, 3.5 million; and (2) proportion of PFTs not meeting current guidelines, 39% (95% CI, 0.31 to 0.47). Local data were used when estimates were not available in the literature: (1) proportion of laparotomies that are elective, 76% (95% CI, 0.73 to 0.79); and (2) frequency of PFTs before laparotomy, 69% (95% CI, 0.54 to 0.84). Estimated annual national real costs for preoperative PFTs are $25 million to $45 million. If use of PFTs were reduced by our estimate for the proportion of PFTs not meeting current guidelines, potential annual national cost savings would be $7,925,411 to $21,406,707. National reimbursement expenditures by third-party payers range from more than $90 million to more than $235 million. If use were reduced, potential annual savings in reimbursements would be $29,084,076 to $111,345,440. Potential savings to Medicare approach $8 million to $20 million annually.

Conclusion: Reduced use of PFTs before elective abdominal surgery could generate substantial savings. Current evidence indicates reduced use would not compromise patients' outcomes.


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