Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial.
cost-benefit analysis
hospital costs
nerve block
postoperative pain
pudendal nerve
Journal
ClinicoEconomics and outcomes research : CEOR
ISSN: 1178-6981
Titre abrégé: Clinicoecon Outcomes Res
Pays: New Zealand
ID NLM: 101560564
Informations de publication
Date de publication:
2021
2021
Historique:
received:
16
02
2021
accepted:
19
04
2021
entrez:
6
5
2021
pubmed:
7
5
2021
medline:
7
5
2021
Statut:
epublish
Résumé
Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy. From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed. Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of -243 ± 881 EUR/pain unit on the VAS. Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.
Sections du résumé
BACKGROUND
BACKGROUND
Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy.
METHODS
METHODS
From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed.
RESULTS
RESULTS
Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of -243 ± 881 EUR/pain unit on the VAS.
CONCLUSION
CONCLUSIONS
Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.
Identifiants
pubmed: 33953578
doi: 10.2147/CEOR.S306138
pii: 306138
pmc: PMC8088981
doi:
Types de publication
Case Reports
Clinical Trial
Langues
eng
Pagination
299-306Informations de copyright
© 2021 Mongelli et al.
Déclaration de conflit d'intérêts
All authors have no conflicts of interest or financial ties to disclose.
Références
Health Aff (Millwood). 2013 Apr;32(4):713-23
pubmed: 23569051
Dis Colon Rectum. 2004 Jul;47(7):1164-9
pubmed: 15148647
Can J Anaesth. 2006 Jun;53(6):579-85
pubmed: 16738292
BMC Health Serv Res. 2018 Feb 5;18(1):84
pubmed: 29402271
Lancet. 2016 Nov 12;388(10058):2375-2385
pubmed: 27726951
J Laparoendosc Adv Surg Tech A. 2019 May;29(5):608-613
pubmed: 30807244
BMJ. 2013 Jun 07;346:f3197
pubmed: 23747967
Int J Colorectal Dis. 2020 Sep;35(9):1741-1747
pubmed: 32474710
Am J Gastroenterol. 2019 May;114(5):798-803
pubmed: 30741736
Asian J Surg. 2006 Jul;29(3):128-34
pubmed: 16877209
Int J Colorectal Dis. 2009 Mar;24(3):335-44
pubmed: 19037647
Int J Colorectal Dis. 2016 Aug;31(8):1529-31
pubmed: 26971350
Lancet. 2016 Jul 23;388(10042):356-364
pubmed: 27236344
Reg Anesth Pain Med. 2003 May-Jun;28(3):228-32
pubmed: 12772141
Int J Colorectal Dis. 2012 Apr;27(4):483-7
pubmed: 22052040
Br J Surg. 2015 Dec;102(13):1603-18
pubmed: 26420725
Cancer Med. 2019 Jun;8(6):3250-3260
pubmed: 31062522
Tech Coloproctol. 2010 Nov;14 Suppl 1:S1-3
pubmed: 20683750
Knee. 2017 Mar;24(2):197-206
pubmed: 28117216
Dis Colon Rectum. 2000 Dec;43(12):1666-75
pubmed: 11156449
Dis Colon Rectum. 2021 May;64(5):617-631
pubmed: 33591044
Ann Ital Chir. 2012 Mar-Apr;83(2):129-34
pubmed: 22462333
J Gastrointest Surg. 2019 Mar;23(3):580-586
pubmed: 30215201
Can J Anaesth. 2005 Jan;52(1):62-8
pubmed: 15625258
World J Surg. 2017 Feb;41(2):603-614
pubmed: 27766395
Int J Surg. 2008;6 Suppl 1:S53-5
pubmed: 19246266