Evaluating intraoperative therapeutic and diagnostic interventions.

Abstract

A cost-conscious health care system requires detailed measures of its activities, including measurements of care provided to perioperative patients. Because there are no scoring systems that quantify the extent of intraoperative care interventions, we developed an intraoperative therapeutic intensity score (I-TIS). Physiological/biochemical monitoring and therapeutic interventions were assigned one to four points on the basis of the resource utilization and/or intensity of care they each reflect. Scoring was performed on actual patients, and the results were compared with ASA classification and surgical complexity. A 78-item scoring system was developed and assessed by using two patient groups. Group 1 (n = 307) entered the postanesthesia care unit (PACU) for short postoperative stays and had an I-TIS of 7.3 +/- 5.0; Group 2 patients (n = 443) were either admitted to the surgical, cardiothoracic, or neurosurgical intensive care units or had extended PACU stays, and they had an I-TIS of 25.2 +/- 12.4 (P < 0.001 versus Group 1). The correlation of I-TIS with the surgical complexity classification was r = 0.77, with ASA base relative value units was r(s) = 0.75, and with the ASA physical status classification was r(s) = 0.49. The score correlated well with surgical complexity and was able to differentiate between the intensity of care during various surgical procedures. A scoring system to quantify the extent of nonsurgical intraoperative care was developed. The scoring system was validated and correlated well with surgical complexity; it was able to differentiate between the intensity of care provided during various surgical procedures.