Economic impact of the consensus conference guidelines on postoperative artificial nutrition in elective surgery in the Rhone-Alpes area.

Objectives: To assess the economic impact of the French guidelines produced by the 1994 consensus conference on postoperative artificial nutrition (AN ) in elective surgery. Study design: Multicentre before-after study, conduc ted on a cost-containment model from the hospital perspective. patients and methods: Ten hospitals were randomly selected in the Rhone-Alpes area, aft er a stratification of hospital category. Twenty consecutive patients, who underwent upper and lower abdominal surgery in each hospital, were included over each study period. Data were collected on site by investigators from patients' records before (1994) and after (1995) guidelines had been circul ated. The calculated costs were direct and partial medical and non medical staff costs of a one-day parenteral nutrition. They included nutrients, dis posable devices, staff time and laboratory tests. Results: Between 1994 and 1995, the study showed a 7.4% decrease in the pos toperative prescription rate of AN, a 4.7% increase in the duration of AN a nd a 3.6% (FF 74.07 constant francs per patient) increase in the total cost of AN in surgical patients. Guidelines had mainly a positive impact in pat ients suffering from denutrition, as the duration of postoperative AN incre ased by 23.7% in this group, leading to a 65.1% (FF 175.53) increase in cos t in 1995. Conclusions: The cost variable is a valuable indicator of the impact of pra ctice guidelines, as it includes the rate and duration of prescriptions. Th e consensus conference had a significant impact in patients suffering from denutrition. Conversely, only minor changes in practices concerning patient s non suffering from denutrition have been observed, leading to a slight co st increase in AN. (C) 1999 Elsevier, Paris.