Skip to main content
Search
Search
Advanced Search
Skip main navigation
Open access
Research Article
27 April 2021

Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting

Authors: Jianying Zhang https://orcid.org/0000-0002-6086-309X [email protected], Wei Jiang, and Felipe UrdanetaAuthor Info & Affiliations
Volume 10, Number 10
https://doi.org/10.2217/cer-2021-0068
PDFFormats

Abstract

Aim: Compared with direct laryngoscopy (DL), video laryngoscopy (VL) offers clinical benefits in routine and difficult airways. The health economic benefit of VL versus DL for routine tracheal intubation remains unknown. Materials & methods: This analysis compared VL and DL health economic outcomes, including total inpatient costs, length of hospital stay (LOS), postoperative intensive care unit (ICU) admission and incidence of procedurally associated complications. Results: Patients with VL had decreased inpatient cost (US$1144–5891 across eight major diagnostic categories [MDC]); >1-day LOS reduction in five MDC; reduced odds for postoperative ICU admission (0.04–0.68) and reduced odds of respiratory complications in three MDC (0.43–0.90). Conclusion: Video laryngoscopy may lower total costs, reduce LOS and decrease the likelihood of postoperative ICU admission.

Lay abstract

In this study, we compared the difference in hospital cost, length of hospital stay, post-surgery complications and post-surgery intensive care unit (ICU) admission between two groups of patients. Both groups of patients were admitted to the hospital for a surgical procedure and underwent general anesthesia for at least 1 h. Before administering anesthesia for surgery, an anesthesiologist inserts a tube into the patient's airway to ventilate the patient. The anesthesiologist might use different types of laryngoscope to assist with the insertion of the tube. The choice of the laryngoscope type is based on several factors such as the availability of the device, doctor's experience, preference and patient's medical and physical conditions. This study focuses on two different types of laryngoscopes: the video laryngoscope and the direct laryngoscope. Patients who received video laryngoscope or direct laryngoscope were divided into separate groups. We made sure that these two groups of patients were comparable in terms of similar age, gender and disease conditions, stayed in similar types of hospitals and had similar procedures. Compared with the direct laryngoscope group, the video laryngoscope group had lower hospital costs (reduced by US$1144–5891), at least 1-day shorter length of hospital stay, reduced rates of ICU admission and fewer complications. This study indicates that video laryngoscopy offers benefits over direct laryngoscopy for elective surgical procedures.

Formats available

You can view the full content in the following formats:

View PDFView Full Text

Supplementary Material

File (supplementary material.docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Durbin CG Jr, Bell CT, Shilling AM. Elective intubation. Respir. Care 59(6), 825–846; discussion 847–829 (2014).
PubMed
Google Scholar
2.
Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane systematic review. Br. J. Anaesth. 119(3), 369–383 (2017).
PubMed
Google Scholar
3.
Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst. Rev. 11, CD011136 (2016).
PubMed
Google Scholar
•• Indicates that video laryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway.
4.
Cook TM, Macdougall-Davis SR. Complications and failure of airway management. Br. J. Anaesth. 109(Suppl. 1), i68–i85 (2012).
PubMed
Google Scholar
• Suggests that analysis of major airway complications identifies areas where practice is suboptimal; research to improve understanding, prevention and management of such complications remains a priority.
5.
Li G, Warner M, Lang BH, Huang L, Sun LS. Epidemiology of anesthesia-related mortality in the United States, 1999–2005. Anesthesiology 110(4), 759–765 (2009).
PubMed
Google Scholar
6.
Aziz MF, Brambrink AM, Healy DW et al. Success of intubation rescue techniques after failed direct laryngoscopy in adults: a retrospective comparative analysis from the Multicenter Perioperative Outcomes Group. Anesthesiology 125(4), 656–666 (2016).
PubMed
Google Scholar
7.
Apfelbaum JL, Hagberg CA, Caplan RA et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 118(2), 251–270 (2013).
PubMed
Google Scholar
•• Summarizes that meta-analyses of randomized controlled trials comparing video-assisted laryngoscopy with direct laryngoscopy in patients with predicted or simulated difficult airways report improved laryngeal views, a higher frequency of successful intubations, and a higher frequency of first attempt intubations with video-assisted laryngoscopy.
8.
Norskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrom LH. Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia 70(3), 272–281 (2015).
PubMed
Google Scholar
•• Demonstrates that more than 90% of the difficulty in intubation was unanticipated.
9.
Paix AD, Williamson JA, Runciman WB. Crisis management during anaesthesia: difficult intubation. Qual. Saf. Health Care 14(3), e5 (2005).
PubMed
Google Scholar
•• Confirms that difficulty in intubation was unexpected. All anesthetists should have a pre-formed strategy for intubation of the difficult airway.
10.
Paolini JB, Donati F, Drolet P. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can. J. Anaesth. 60(2), 184–191 (2013).
PubMed
Google Scholar
11.
Kelly FE, Cook TM. Seeing is believing: getting the best out of videolaryngoscopy. Br. J. Anaesth. 117(Suppl. 1), i9–i13 (2016).
PubMed
Google Scholar
• Indicates that the potential benefits of videolaryngoscopy for patients are numerous and significant. However, the performers need to be accompanied by appropriate training.
12.
Berkow LC, Morey TE, Urdaneta F. The technology of video laryngoscopy. Anesth. Analg. 126(5), 1527–1534 (2018).
PubMed
Google Scholar
13.
Cook TM, Boniface NJ, Seller C et al. Universal videolaryngoscopy: a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department. Br. J. Anaesth. 120(1), 173–180 (2018).
PubMed
Google Scholar
• Demonstrates that the results from a formal and prolonged trial convinced the provider to agree to use video laryngoscopy as the first-line intubation technique.
14.
Pieters BM, Eindhoven GB, Acott C, Van Zundert AA. Pioneers of laryngoscopy: indirect, direct and video laryngoscopy. Anaesth. Intensive Care 43(Suppl.), 4–11 (2015).
PubMed
Google Scholar
15.
Woodward M. Epidemiology: Study Design and Data Analysis. Chapman and Hall, Boca Raton (1999).
Google Scholar
16.
Rusticus S, Lovato C. Impact of sample size and variability on the power and type I error rates of equivalence tests: a simulation study. Practi. Assess. Res. Eval. 19, Article 11 (2014).
Google Scholar
17.
Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can. J. Anaesth. 41(5 Pt 1), 372–383 (1994).
PubMed
Google Scholar
18.
Schroeder RA, Pollard R, Dhakal I et al. Temporal trends in difficult and failed tracheal intubation in a regional community anesthetic practice. Anesthesiology 128(3), 502–510 (2018).
PubMed
Google Scholar
19.
Law JA, Broemling N, Cooper RM et al. The difficult airway with recommendations for management--part 1--difficult tracheal intubation encountered in an unconscious/induced patient. Can. J. Anaesth. 60(11), 1089–1118 (2013).
PubMed
Google Scholar
20.
Frerk C, Mitchell VS, Mcnarry AF et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br. J. Anaesth. 115(6), 827–848 (2015).
PubMed
Google Scholar
21.
Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology 114(1), 34–41 (2011).
PubMed
Google Scholar
22.
Roth D, Pace NL, Lee A et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst. Rev. 5, CD008874 (2018).
PubMed
Google Scholar
23.
Parotto M, Cooper R. Recent advances in laryngoscopy in adults. F1000Res 8, (2019).
Crossref
PubMed
Google Scholar
24.
Nagy B, Rendeki S. A national survey of videolaryngoscopes and alternative intubation devices in Hungary. PLoS ONE 14(10), e0223645 (2019).
PubMed
Google Scholar
25.
Liu DX, Ye Y, Zhu YH et al. Intubation of non-difficult airways using video laryngoscope versus direct laryngoscope: a randomized, parallel-group study. BMC Anesthesiol. 19(1), 75 (2019).
PubMed
Google Scholar
26.
Alsumali A, Noppens R. Cost–effectiveness of video laryngoscopy for routine use in the operating room. Trends Anaesth. Crit. Care 23, 10 (2018).
Google Scholar
27.
Moucharite M, Zhang J, Giffin R. Factors and economic outcomes associated with documented difficult intubation in the United States. ClinicoEconomics Outcomes Res. 13, 227–239 (2021).
PubMed
Google Scholar
•• Demonstrates that the difficult and failed intubation is associated with longer length of stay and higher cost.
|