Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature.

BACKGROUND AND OBJECTIVES: In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. METHODS: A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). RESULTS: One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. CONCLUSIONS: Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.

Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature

Abstract Background and objectives: In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. Methods: A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). Results: One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. Conclusions: Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.

Obstacles associated with organizational change.

This article briefly explores one view of the change process, discusses obstacles to change, the means to deal with these obstacles, and describes change principles and specific examples of change strategies that commonly work.

Tobacco and alcohol during pregnancy: prevalence and determinants in Geneva in 2008.

OBJECTIVES: To describe alcohol and tobacco consumption during pregnancy in women giving birth in a public hospital in Geneva, to evaluate risk factors related to these consumptions and to explore the influence of close relatives on the consumption habits of pregnant women. METHODS: A cross-sectional questionnaire survey after delivery in 207 women in the maternity ward of the Geneva University Hospitals in 2008. We used retrospective self-reports of smoking during pregnancy (including temporary smoking), smoking during the entire pregnancy and alcohol drinking during pregnancy (even a single glass). RESULTS: The proportion of smokers decreased from 31.2% before pregnancy to 21.7% during pregnancy (temporary smoking included), and 9.2% of women smoked continuously until delivery. Major factors associated with tobacco use were living alone, living with a smoker and tobacco consumption of the husband/partner in the presence of the pregnant woman. Regarding alcohol consumption, 62.7% of the participants reported drinking (even occasionally) before pregnancy, and 36.3% of the women drank at least one glass of alcohol during pregnancy. The alcohol consumption of the husband/partner and invitations to drink from other people were associated with alcohol consumption during pregnancy. CONCLUSIONS: Among women delivering in a public hospital, tobacco and alcohol consumption during pregnancy was important and significantly influenced by the habits and attitude of close relatives. The involvement of relatives in health promotion interventions should be addressed.