Economic implications of an early postoperative enteral feeding protocol

Objective To study the cost-effectiveness of an early postoperative feeding protocol for patients undergoing bowel resections. Design A nonrandomized, prospective, clinical trial. Surgeons elected to participate in the treatment arm before the study's outset. Subjects/setting Treatment (n = 66) and control (n = 159) patients were admitted to a nonprofit general teaching hospital in the Texas Medical Center for similar diagnoses and subsequent bowel resections during an 18-month period. Intervention Treatment patients who met specific inclusion criteria had a jejunal feeding tube placed during surgery. Tube feedings were initiated within 12 hours after surgery. Control patients who met the same inclusion criteria received usual care. Outcomes A successful outcome was defined as a patient developing no postoperative infection. The average cost of a nosocomial infection is presented. Variable direct and total costs (fixed plus variable) are compared between patient groups. Statistical analysis Mean cost was adjusted for rate of success in each patient group according to an analytic model. The mean cost difference between groups was analyzed by independent-samples t tests. Nonparametric Mann-Whitney rank stun tests were used to determine the cost significance of a nosocomial infection. Results The average variable direct cost savings per successful treatment patient was $1,531, which required an additional variable cost of $108.30 for the dietitian's time. The protocol resulted in a total cost savings of $4,450 per success in the treatment group. Conclusion An early postoperative enteral feeding protocol as part of an outcomes management program for patients undergoing bowel resection is cost-effective.
Health care costs in the United States, which in 1996 accounted for 13.6% of the gross domestic product, have increased at a faster rate than in any other nation (1-4). [...]