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. 2023 Dec 30;14(1):58.
doi: 10.3390/jpm14010058.

Personalized Predictive Hemodynamic Management for Gynecologic Oncologic Surgery: Feasibility of Cost-Benefit Derivatives of Digital Medical Devices

Luciano Frassanito  1 , Rossella Di Bidino  2 , Francesco Vassalli  3 , Kristian Michnacs  4 , Pietro Paolo Giuri  1 , Bruno Antonio Zanfini  1 , Stefano Catarci  1 , Nicoletta Filetici  1 , Chiara Sonnino  1 , Americo Cicchetti  5 , Giovanni Arcuri  2 , Gaetano Draisci  1
Affiliations

Personalized Predictive Hemodynamic Management for Gynecologic Oncologic Surgery: Feasibility of Cost-Benefit Derivatives of Digital Medical Devices

Luciano Frassanito et al. J Pers Med. .

Abstract

Background: Intraoperative hypotension is associated with increased perioperative complications, hospital length of stay (LOS) and healthcare expenditure in gynecologic surgery. We tested the hypothesis that the adoption of a machine learning-based warning algorithm (hypotension prediction index-HPI) might yield an economic advantage, with a reduction in adverse outcomes that outweighs the costs for its implementation as a medical device.

Methods: A retrospective-matched cohort cost-benefit Italian study in gynecologic surgery was conducted. Sixty-six female patients treated with standard goal-directed therapy (GDT) were matched in a 2:1 ratio with thirty-three patients treated with HPI based on ASA status, diagnosis, procedure, surgical duration and age.

Results: The most relevant contributor to medical costs was operating room occupation (46%), followed by hospital stay (30%) and medical devices (15%). Patients in the HPI group had EURO 300 greater outlay for medical devices without major differences in total costs (GDT 5425 (3505, 8127), HPI 5227 (4201, 7023) p = 0.697). A pre-specified subgroup analysis of 50% of patients undergoing laparotomic surgery showed similar medical device costs and total costs, with a non-significant saving of EUR 1000 in the HPI group (GDT 8005 (5961, 9679), HPI 7023 (5227, 11,438), p = 0.945). The hospital LOS and intensive care unit stay were similar in the cohorts and subgroups.

Conclusions: Implementation of HPI is associated with a scenario of cost neutrality, with possible economic advantage in high-risk settings.

Keywords: gynecologic oncologic surgery; healthcare resource utilization; intraoperative hypotension; length of stay; machine learning.

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Conflict of interest statement

L.F. received honoraria from Edwards Lifesciences Ltd. for scientific advice. K.M. is an employee of Edwards Lifesciences GmbH, and holds shares in Edwards Lifesciences.

Figures

Figure 1
Figure 1
Median costs expressed in EUR of hospitalization and surgery in HPI (hypotension prediction index) and control GDT (goal-directed therapy) groups. ICU: intensive care unit.
See this image and copyright information in PMC

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