To estimate the effect of a PPC on hospital costs and length of stay (LOS).
To model the health economics of implementing physiotherapy interventions that prevent PPCs.
Patient-level data from five prospective studies involving 1473 adults undergoing major elective and emergency abdominal surgery at five hospitals in Australia and New Zealand were combined. PPCs were detected prospectively using a standardized diagnostic screening tool daily for the first seven postoperative days and graded in severity dependent on escalation of oxygen therapy. Hospital costings for each episode of care were extracted from government databases.
Multivariate regression modelling estimated the effect of PPC on hospital costs and LOS adjusted for confounding effects of age, comorbidities, surgery urgency, duration, and type of procedure. Costings are reported in Australian dollars with inflation values to 2024.
Cost-benefit modelling using systematic review evidence of physiotherapy interventions to prevent PPC was conducted.
The PPC incidence was 19% (280/1473) within this multicenter international cohort (mean age 64, 56% male, 50% multiple comorbidities) of adults having major abdominal surgery (46% emergency laparotomy, 50% colorectal, 19% upper gastrointestinal, 15% urological)
The average episode of care hospital cost was $34,000 (95% CI $31K to $36K).
A PPC was independently and strongly associated with additional hospital costs of $29,000 (p001; 95% CI $22K to $36K). Even mild PPCs had significant cost implications (additional $20,000; 95% CI $11K to $29K). Severe PPCs cost hospitals an additional $55,000 to manage (95% CI $39K to $70K).
Hospital LOS was 8 to 11 days longer for patients who developed a PPC (adjusted mean difference 9 days, p001).
Modelling finds that preoperative physiotherapy education, preoperative inspiratory muscle training, and prehabilitation would be cost saving to the hospital paying for the service, with $485K, $286K and $130K saved for every 100 patients treated, respectively.
This individual patient meta-analysis from five studies involving public hospitals in Australia and New Zealand finds that a PPC after major abdominal surgery cost between $22,000 to $36,000 to manage and extended LOS by 8 to 11 days.
Health economic modelling finds that physiotherapy interventions known to reduce PPC rates would provide a large cost-benefit to hospitals, if implemented.
As PPCs cost hospitals a significant amount to treat, broadscale implementation of preoperative physiotherapy, inspiratory muscle training and high-intensity supervised prehabilitation would be significantly cost-saving to the healthcare system due to their large impacts on reducing PPCs alone.
cost savings
health economics
