Comparison of peripheral nerve blocks, spinal and general anesthesia in outpatients undergoing long saphenous vein stripping. a cost-analysis study

Introduction: With increasing national attention on health care costs, there is growing demand for more cost-effective anesthetic management. In this study, the cost of anesthesia drugs and supplies, cost of the operating room (OR) utilization, and cost of care in the post-anesthesia care unit (PACU), were compared among three anesthetic techniques used for long saphenous vein stripping (LSVS) in an outpatient setting. Methods: Medical records of 66 patients of ASA classes I and II who underwent long saphenous vein phlebectomy in 1994 were examined. The study variables were defined as follows: OR time = patient enters the OR to patient leaves the OR, PACU time = patient enters the PACU to patient leaves the PACU. Costs of using OR and the PACU was then calculated according to the existing rates in our institution (OR cost: first half hour = $1000, each additional 1/2 hour = $400; PACU cost: first hour = $242, 2 hours = $321, 3 hours= $402). Total cost = cost of anesthesia drug and supplies + cost of OR time + cost of PACU care. The cost of intravenous catheters, infusion sets, IV fluids, and costs of supplies specific for each anesthesia technique (i.e., endotracheal tubes, spinal and block needles etc.), was added to the total cost for each group. The cost of inhalational agents was based on the fresh gas flowrateof41iters[l]. Results: Sixty-six patients were included in the analysis. The mean age of the group as a whole was 48 ± 11 yrs, 72% women and 28% men, without significant difference in age or sex between the groups. The mean duration of surgery was 46 ±15 min. The main results are summarized in Table 1. Table 1. Peripheral nerve blocks vs. spinal vs. general anesthesia. A cost-analysis. Anesthesia No#of Drug+ PACUcost OR cost $ Total cost S technique cases Supplies $ $ Nerve blocks (PNB) 27 19 ±5 302 ±39 1666 ±221 ~1995± 229 Spinal 14 23 ±2 333 ±42 1742 ±145 2107 ±156 General 25 62 ±9 297 ±47 1896 ±174 2263 ±190 p-value p= 0.001p=0.1* p= 0.001* p= 0.001* Legend: PNB= femoral nerve block with 3% alkalinized chloroprocaine and genitofemoral nerve block with 1% lidocaine, Spinal= spinal anesthesia with 75mg of hyperbaric 5% lidocaine, * Student's t-test. Bonferroni-adjusted comparisons revealed that the cost of anesthesia drugs and supplies in the PNB and spinal groups, and the cost of OR utilization in the PNB group remained significantly less compared to that of the general anesthesia group. The use of the PNB technique was associated with a statistically significant reduction in total cost by $268 when compared with general anesthesia (p=0.001). Conclusion: Our results suggest that regional anesthesia (nerve blocks and spinal anesthesia) is a more cost-effective anesthetic technique for outpatients undergoing LSVS. Although the observed savings associated with the use of regional anesthesia may not significantly affect total health costs, the absolute savings in direct costs at the departmental level can be significant. This could be of vital importance if and when capitated reimbursement for surgical and anesthesia services becomes instituted.