Switching post-cardiac surgery patients from inhaled nitric oxide to epoprostenol reduced pulmonary vasodilator costs by 31.4% with similar clinical outcomes and shorter ICU stays.
Does inhaled epoprostenol reduce costs and maintain clinical outcomes compared to inhaled nitric oxide in post-cardiac surgery patients?
A quality improvement initiative switching from inhaled nitric oxide to epoprostenol in post-cardiac surgery patients reduced vasodilator costs by 31.4% and was associated with shorter ICU and hospital stays without compromising clinical outcomes.
Absolute Event Rate: 0% vs 0%
Abstract Background Pulmonary vasodilators such as inhaled nitric oxide (iNO) and inhaled epoprostenol, are commonly used in post-cardiac surgery patients with right ventricular (RV) failure, pulmonary hypertension, and refractory hypoxaemia. Despite recent studies indicating similar clinical outcomes between the two agents, iNO is often preferred due to its familiarity, though it is more expensive. This Quality Improvement (QI) project aimed to reduce healthcare costs by promoting the use of epoprostenol over iNO in the Cardiothoracic Intensive Care Unit (CTICU) of a large academic medical centre. Aim To reduce the cost of pulmonary vasodilator use by 30% over three months in post-cardiac surgery patients requiring pulmonary vasodilation for RV failure, pulmonary hypertension, or refractory hypoxaemia. Methods This prospective, single-centre QI project was conducted in the CTICU of a large academic centre from September to November 2023, with three phases: pre-intervention (September), intervention (October), and post-intervention (November). In the pre-intervention phase, iNO was the primary vasodilator. During the intervention phase, the use of epoprostenol was encouraged through provider education focusing on the cost differences. Key stakeholders including ICU providers, respiratory therapists, and pharmacists were educated via emails, presentations, and meetings. Data from patients receiving either iNO or epoprostenol during the study period were collected and analysed, comparing clinical outcomes and costs. Results A total of 25 post-cardiac surgery patients received pulmonary vasodilators during the study period, with 14 receiving epoprostenol and 11 receiving iNO. Baseline characteristics were similar between the groups, with no significant differences in age, sex, or race. Both groups had comparable rates of improvement in RV function, pulmonary hypertension, and hypoxaemia (p 0. 05). However, the epoprostenol group had a significantly shorter ICU stay (13. 5 vs. 30. 8 days, p = 0. 045) and total hospital stay (21. 4 vs. 49 days, p = 0. 024) compared to the iNO group. Mortality, re-intubation, and tracheostomy rates were similar across groups. Epoprostenol usage increased from 239 hours pre-intervention to 1, 750 hours post-intervention, while iNO usage decreased from 1, 381 hours to 183 hours. Consequently, the cost of pulmonary vasodilators decreased significantly, from 29, 912. 70 in the pre-intervention phase to 24, 618. 10 post-intervention, representing a 31. 4% cost reduction. If projected to 2024, there would have been a 55. 6% cost reduction due to the expected rise in iNO costs based on updated hospital contracts. Conclusion Switching from iNO to epoprostenol resulted in similar clinical outcomes, while generating significant cost savings. This transition underscores that, with proper education and clinical guidelines, healthcare costs can be reduced without impacting patient care.
Hegde et al. (Sat,) reported a other. Switching post-cardiac surgery patients from inhaled nitric oxide to epoprostenol reduced pulmonary vasodilator costs by 31.4% with similar clinical outcomes and shorter ICU stays.