INVOS regional oximetry in cardiac surgery outcomes: A valuation analysis

Several hospitals are conducting an analysis of how monitoring cerebral oximetry during open heart surgery impacts patient outcomes and their related costs.

More high-risk, high-liability patients are using the hospital systems. Although only 5 percent of the U.S. population is considered to be high-risk, that patient cohort uses between 45 and 50 cents of every dollar spent on healthcare. A recent webinar hosted by Becker's Hospital Review discussed methods for averting this risk for cardiac surgery patients. The impact of changing healthcare economic environment on cardiac surgical programs and one technology that has potential to have a postiive impact on the care and outcomes of cardiac patients and reduce the financial burden related to post-operative complications and prolonged icu and hospital stays.

The presentation, hosted by medical technology company Covidien, recently acquired by Medtronic, featured David A. Theodoro, MD, cardiac surgeon and chairman of the cardiovascular department at SSM Health in St. Louis; Julie Pettigrew, director of marketing for U.S. advanced parameters at Medtronic's Respiratory and Monitoring Solutions; and Robert Palmer, president and CEO of PotientiaMED, an Austin, Texas-based data health care analytics company which is partnering with Medtronic on a comparative effectiveness analysis project related to the use of cerebral oximetry during cardiac surgery. 

The monitoring system, called INVOS, is a noninvasive monitoring technology that measures the blood oxygenation of the brain during surgery to determine the adequacy of the blood supply to the brain. Between 23 and 37 percent of patients in cardiac surgery experience some level of cerebral hypoxia. Cerebral hypoxia has been linked to post-operative complications including neurological injury and can lead to extended hospital stays or potential cognitive damage. The occurrence of cerebral oxygen desaturation has been to be reported as high as 69 to 75 percent in the high-risk patient population.

"What we're talking about goes so far beyond a particular device for sale," Ms. Pettigrew said. "Whether you're a clinician, we all have a common concern, and that is all about the patient and the patient's quality of life."

Only approximately 30 percent of all adult cardiac surgery procedures in the US are monitored using cerebral oximetry, Ms. Pettigrew said. Dr. Theodoro pressed the importance of monitoring during surgery, citing statistics that show patients whose oxygenation  is monitored during cardiac surgery  room do not experience as many post-operative issues as patients who are not monitored.

When cerebral oxygen monitoring is used to guide patient care and support during cardiac surgery utilized, only 3 percent of patients experience major organ morbidity and mortality, these complications include death within 30 days of the procedure and neurological injury, renal failure, extended need for mechanical ventilation, extended ICU and overall hospital stay.

"More likely than not, the brain and its adequacy of blood supply serves as a surrogate of the adequacy of blood supply to other important organ systems," he said.

In the Covidien-run comparative effectiveness analysis, five years of retrospective data will be collected from cardiac surgical centers using the INVOS system and from centers that have not adopted the use of cerebral oxygen monitoring. PotentiaMED will perform detailed analysis of the de-identified data and will compare the outcomes of cardiac surgical patients monitored with the INVOS system and those not monitored, Mr. Palmer said. The proprietary analytics model developed and to be employed for this analysis will account for regional differences in cost as well as institution -to- institution variability in patient population. The final analysis will be shared with the participating centers to  better understand the impact of INVOS monitoring and how to optimize its use in the cardiac surgical patient population, he said.

"The statistical models used take into account adjustments with respect to region differences in care practices and population as well as what we've defined as intensity of stay," Mr. Palmer said. "We've done that by taking data from multiple institutions and identify what are the key underlying factors impacting patient outcomes factors, and then the models are always learning."

Medtronic plans to schedule another webinar with Becker's Hospital Review to discuss the results of the trial after the 15 to 16 week window has passed and the company has definitive results, Ms. Pettigrew said. Potential benefits for participating hospitals include inclusion in a progressive health care analytics project, hospital-specific clinical and economic insight, a comparative effectiveness report and potential inclusion in publications, she said.

The main purpose of the technology is to identify and avoid events during cardiac surgery that can harm the patient. High-risk patients are a major consideration in a changing healthcare environment, Dr. Theodoro said. Reimbursements are declining while procedure costs are rising, and hospitals are prioritizing how to transitions to a risk-bearing, value-based model.

Reducing the negative outcomes and admissions of these high-risk patients can help alleviate some of the cost to hospitals, he said. He emphasized the use of population health data to calculate the best possible risks but to focus treatment on the individual in practice.

"Now, a population does not enter your ED — an individual does," Dr. Theodoro said. "When these high-risk patients touch our systems in primary high-acuity arenas, what are we going to bring to bear in that patient population to induce positive outcomes? Clearly, the answer is complicated and multi-factorial."

View the webinar by clicking here

Note: View archived webinars by clicking here.

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