Direct Cost of Anesthesia in Traumatic Patients with Massive Bleeding: a Prospective Micro-Costing Study
Cost of Anesthesia in Trauma Patients
Keywords:anesthesia, cost, cost-to-charge ratio, massive bleeding, trauma
Objective:This study aimed to quantify the direct cost as well as cost-to-charge ratio of anesthetic care in traumatic patients with intraoperative massive bleeding.
Material and Methods: This study was a prospective observational cost analysis study, conducted in Songklanagarind Hospital, Thailand. Traumatic patients from any mechanisms were recruited. Massive bleeding was defined as estimated blood loss of at least one blood volume in 24 hours or a half of blood volume in 3 hours. The cost components were valued by the bottom-up approach. The direct cost was divided into 4 categories; the labor cost, the capital cost, the material cost and the cost of drugs.
Results: From September 2017 to August 2018; 10 eligible patients were included. Seven patients had motorcycle accidents, two patients fell from height and another one was in a minibus accident. Two patients died on the operating table, and another two died within 48 hours. The median direct cost per case was 9,321 Baht (264 United States Dollars), and the cost-to-charge ratio was 0.62. The median Sequential Organ Failure Assessment Score was 8. The median intraoperative blood loss was 3,500 millimeters.
Conclusion: Our study provided information on the direct costs of anesthesia in traumatic patients with massive bleeding. The direct cost was 62.0% of the hospital charge. However, this study did not analyze the indirect cost.
Capan LM, Miller SM, Gingrich KJ. Trauma and burns. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical Anesthesia. 7th ed. Philadelphia: Wolters Kluwer| Lippincott Williams & Wilkins; 2013;p.1498-502.
Johnstone RE, Martinec CL. Costs of Anesthesia. Anesth Analg 1993;76:840-8.
Macario A. What does one minute of operating room time cost? J Clin Anesth 2010;22:233-6.
Stainsby D, MacLennan S, Hamilton PJ. Management of massive blood loss: a template guideline. Br J Anaesth 2000;85:487-91.
Hendriks ME, Kundu P, Boers AC, Bolarinwa OA, Te Pas MJ, Akande TM, et al. Step-by-step guideline for diseasespecific costing studies in low- and middle-income countries: a mixed methodology. Glob Health Action 2014;7:23573.
Kramer EJ, Shearer DW, Marseille E, Haonga B, Ngahyoma J, et al. The cost of intramedullary nailing for femoral shaft fractures in Dar es Salaam, Tanzania. World J Surg 2016;40:2098-108.
Forman SA, Ishizawa Y. Inhaled anesthetic pharmacokinetics: uptake, distribution, metabolism, and toxicity. In: Miller RD, editors. Miller’s Anesthesia. 8th ed. Philadelphia: Elsevier; 2015; p.640.
Pierthong J. Cost analysis of anesthesia service, Police General Hospital [abstract]. J Police Nurses 2013;5:137-48.