OBJECTIVES:

Intraoperative hypotension (IOH) in noncardiac surgery entails a humanistic and economic burden associated with a higher risk of mortality and severe adverse events (AEs). Machine learning-derived algorithms, such as the Hypotension Prediction Index (HPI), contribute to reducing IOH depth and duration, minimizing its impact on patients’ recovery. Objectives were twofold: to highlight the impact of AEs of IOH in Spain and estimate potential savings provided by HPI use.

METHODS:

All surgical procedures from 2016 to 2020 by APR-DRG code (ICD10) were obtained from the Minimum Basic Data Set (Ministry of Health, Spain). High-risk surgeries were defined by a yearly mortality rate ≥5%. The burden of IOH in terms of risk of acute kidney injury (AKI) and myocardial infarction after noncardiac surgery (MINS) was estimated from multivariate logistic models in previous large-cohort studies. Additionally, we calculated HPI savings in terms of reduction of median postoperative length of hospital stay (LoS) based on published Spanish evidence. Direct costs related to AEs were estimated using the average costs per AKI (APR-DRG 469), and MINS (APR-DRG 190). Cost of hospitalization was obtained from regional tariffs (€,2022).

RESULTS:

During that period, 120,144/year noncardiac high-risk surgeries (average LoS 7,5 days; 554M€/year) were conducted, accounting for 8% of interventions in Spain and 47% of mortality on average. Adjusted risk-ratios resulted in 72% of patients experiencing IOH events, causing yearly 5,362 AKIs, and 3,185 MINSs, implying a direct cost of 35M€. The use of HPI could minimize IOH-related post-surgery LoS, (median reduction: 2 days per surgery), avoiding 240.289 days yearly, with direct-related saving 148M€ per year.

CONCLUSIONS:

IOH implies a significant economical burden. The potential reduction of IOH by using HPI may result in significant savings considering only hospitalization days until discharge. However, further savings may also be generated if postoperative complications associated with IOH are avoided.