Urinary catheter monitoring of intra-abdominal pressure after major abdominal surgery, a cost-benefit analysis

Abstract

Objective

To estimate costs and benefits associated with measurement of intra-abdominal pressure (IAP).

Methods

We built a cost-benefit analysis from the hospital facility perspective and time horizon limited to hospitalization for patients undergoing major abdominal surgery for the intervention of urinary catheter monitoring of IAP. We used real-world data estimating the likelihood of intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and acute kidney injury (AKI) requiring renal replacement therapy (RRT). Costs included catheter costs (estimated $200), costs of additional intensive care unit (ICU) days from IAH and ACS, and costs of CRRT. We took the preventability of IAH/ACS given early detection from a trial of non-surgical interventions in IAH. We evaluated uncertainty through probabilistic sensitivity analysis and the effect of individual model parameters on the primary outcome of cost savings through one-way sensitivity analysis.

Results

In the base case, urinary catheter monitoring of IAP in the perioperative period of major abdominal surgery had 81% fewer cases of IAH of any grade, 64% fewer cases of AKI, and 96% fewer cases of ACS. Patients had 1.5 fewer ICU days attributable to IAH (intervention 1.6 days vs. control of 3.1 days) and a total average cost reduction of $10,468 (intervention $10,809, controls $21,277). In Monte Carlo simulation, 86% of 1,000 replications were cost-saving, for a mean cost savings of $10,349 (95% UCI $8,978, $11,720) attributable to real-time urinary catheter monitoring of intra-abdominal pressure. One-way factor analysis showed the pre-test probability of IAH had the largest effect on cost savings and the intervention was cost-neutral at a prevention rate as low as 2%.

Conclusions

In a cost-benefit model using real-world data, the potential average in-hospital cost savings for urinary catheter monitoring of IAP for early detection and prevention of IAH, ACS, and AKI far exceed the cost of the catheter.

Keywords:

• Abdominal compartment syndrome
• intra-abdominal pressure
• abdominal surgery
• critical care
• urine catheter

JEL Classification Codes:

• D61
• D6
• D
• I19
• I1
• I
• D81
• D8

Transparency

Declaration of funding

This work was funded by Potrero Medical, Hayward, CA, USA

Role of funding source

The authors take full responsibility for the content of the manuscript. Potrero Medical approved but did not alter the identification, design, conduct and reporting of the analysis.

Declaration of financial/other relationships

VM serves as Chief Medical Officer (CMO) for Potrero Medical.

JPN and EJK is a consultant for Potrero Medical

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

The Deputy Editor in Chief helped with adjudicating the final decision on this paper.

Acknowledgements

None stated.