In Reply:--Our economic analysis of the laryngeal mask airway for outpatient elective surgery provides a model to identify the variables that have the greatest effect on cost-efficiency when determining airway management choice. Jacoby raises several important points. The first is that intraoperative anesthesia costs (i.e., cost per minute of anesthesia) are a small portion (5.6%) of the overall costs related to perioperative care of a surgical patient. Although the cost per case of anesthesia drugs and supplies is small, given the large number of anesthetics administered, small savings per case can represent substantial savings when aggregated. By taking a leadership role in analyses of operating room economics, we will be better able to work with our surgical and nursing colleagues to improve the fiscal profile of surgical care.
In a capitated reimbursement environment, where a healthcare system is paid a fixed amount of money per month to care for a predefined number of covered lives, anesthesiologists need to continually determine how to achieve the best outcomes at the lowest reasonable cost, even if the marginal cost difference between anesthetics is low. Quantitatively defining what is best for the patient can be difficult. In our cost analysis, we placed value on what is best for the patient by factoring in the cost of various complications (i.e., risk of dental injury). We also state that delivering high-quality anesthesia care requires that specific patient preferences regarding airway choice be incorporated into the airway management decision.
We assumed the fresh gas flow used for a face-mask anesthetic (6 l/min in our baseline case) to be greater than the fresh gas flow used for the laryngeal mask airway or the tracheal tube. Certainly, if the flow rates used for the face masks are decreased to 400 ml/min, the face mask becomes an even more economically attractive airway choice for elective outpatient surgery.
Alex Macario, M.D., Pearl Chang, M.B.A., Dan Stempel, M.B.A., John Brock-Utne, M.D., Ph.D., Department of Anesthesia, Stanford University Medical Center, Stanford, California 94305-5115.