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Economic Implications of an Early Postoperative Enteral Feeding Protocol
Author(s) -
Wooley Jennifer A.
Publication year - 2000
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/088453360001500411
Subject(s) - medicine , enteral administration , surgery , protocol (science) , parenteral nutrition , statistical significance , randomized controlled trial , clinical trial , bowel resection , variable cost , prospective cohort study , alternative medicine , accounting , pathology , business
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 sum 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. (J Am Diet Assoc 99:802–807, 1999)