The health economic benefits of perioperative patient warming for prevention of blood loss and transfusion requirements as a consequence of inadvertent perioperative hypothermia.

Active warming of patients is recommended by The National Institute for Health and Care Excellence (NICE) to prevent inadvertent perioperative hypothermia (IPH). This paper examines the cost effectiveness of one consequence of IPH, an increase in blood loss and the resulting transfusion risk. We quantified the risk and modelled two patient pathways, one with and one without warming, across two different surgery types. We were able to demonstrate the cost effectiveness of active warming based on one consequence even allowing for uncertainties in the model.

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia.

BACKGROUND: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. METHODS: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. RESULTS: In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. CONCLUSION: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.

Implementation of an inexpensive method of vitrification and warming of human cleavage-stage embryos using cut standard straws.

The aim of this report is to describe our experience and results with implementation of a cut standard straw technique for vitrification and warming of day 3 cleavage-stage human embryos. Detailed description of the method and results of 63 frozen embryo transfers performed with this technology are discussed, and it is concluded that this method provides a reliable, inexpensive, and effective option of embryo vitrification at a cleaved stage.

Perioperative cost-finding analysis of the routine use of intraoperative forced-air warming during general anesthesia.

BACKGROUND: Despite the well-documented ability of forced-air warming (FAW) to maintain normothermia, it is unclear whether this technique results in a net increase or decrease in costs. The authors did a prospective cost-finding study comparing FAW with routine thermal care in patients at low risk for perioperative complications who were undergoing general anesthesia. METHODS: After institutional review board approval was received, 100 patients were studied who were having elective surgery scheduled for more than 2 h during general endotracheal anesthesia. Patients were randomly assigned to one of two groups: FAW or routine thermal care. All patients received a standardized anesthetic. Anesthesia providers were blinded to core temperatures and the use of FAW. Primary outcomes were those associated with perioperative costs. RESULTS: The time from completion of surgical dressing until tracheal extubation was significantly reduced in the FAW group (10 +/- 1 min compared with 14 +/- 1 min; mean +/- SEM; P < 0.01). There was no demonstrable difference in attainment of postanesthesia care unit discharge criteria between the two groups, although the FAW group used one less cotton blanket there. The net savings related to the use of the FAW depends on the percentage of the intraoperative costs that are fixed rather than variable ($15 additional for FAW if all costs are fixed compared with $29 savings if all costs were variable). CONCLUSIONS: Routine intraoperative FAW significantly reduced time until extubation and use of cotton blankets in the postanesthesia care unit. These results suggest that the influence of FAW on net total perioperative costs depends on patient and surgical characteristics and institutional factors related to cost accounting.