{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T02:48:17Z","timestamp":1784688497042,"version":"3.55.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T00:00:00Z","timestamp":1703894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Intraoperative hypotension is associated with increased perioperative complications, hospital length of stay (LOS) and healthcare expenditure in gynecologic surgery. We tested the hypothesis that the adoption of a machine learning-based warning algorithm (hypotension prediction index\u2014HPI) might yield an economic advantage, with a reduction in adverse outcomes that outweighs the costs for its implementation as a medical device. Methods: A retrospective-matched cohort cost\u2013benefit Italian study in gynecologic surgery was conducted. Sixty-six female patients treated with standard goal-directed therapy (GDT) were matched in a 2:1 ratio with thirty-three patients treated with HPI based on ASA status, diagnosis, procedure, surgical duration and age. Results: The most relevant contributor to medical costs was operating room occupation (46%), followed by hospital stay (30%) and medical devices (15%). Patients in the HPI group had EURO 300 greater outlay for medical devices without major differences in total costs (GDT 5425 (3505, 8127), HPI 5227 (4201, 7023) p = 0.697). A pre-specified subgroup analysis of 50% of patients undergoing laparotomic surgery showed similar medical device costs and total costs, with a non-significant saving of EUR 1000 in the HPI group (GDT 8005 (5961, 9679), HPI 7023 (5227, 11,438), p = 0.945). The hospital LOS and intensive care unit stay were similar in the cohorts and subgroups. Conclusions: Implementation of HPI is associated with a scenario of cost neutrality, with possible economic advantage in high-risk settings.<\/jats:p>","DOI":"10.3390\/jpm14010058","type":"journal-article","created":{"date-parts":[[2023,12,31]],"date-time":"2023-12-31T06:37:12Z","timestamp":1704004632000},"page":"58","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Personalized Predictive Hemodynamic Management for Gynecologic Oncologic Surgery: Feasibility of Cost\u2013Benefit Derivatives of Digital Medical Devices"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6406-2591","authenticated-orcid":false,"given":"Luciano","family":"Frassanito","sequence":"first","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9773-856X","authenticated-orcid":false,"given":"Rossella","family":"Di Bidino","sequence":"additional","affiliation":[{"name":"Department of Health Technology, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5067-9427","authenticated-orcid":false,"given":"Francesco","family":"Vassalli","sequence":"additional","affiliation":[{"name":"Department of Critical Care and Perinatal Medicine, IRCCS Istituto G. Gaslini, 16147 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Michnacs","sequence":"additional","affiliation":[{"name":"Edwards Lifescience GmbH, 85748 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3644-1425","authenticated-orcid":false,"given":"Pietro Paolo","family":"Giuri","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1312-5382","authenticated-orcid":false,"given":"Bruno Antonio","family":"Zanfini","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-6527","authenticated-orcid":false,"given":"Stefano","family":"Catarci","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Filetici","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Sonnino","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Americo","family":"Cicchetti","sequence":"additional","affiliation":[{"name":"Department of Management Studies, Faculty of Economics, Catholic University of Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Arcuri","sequence":"additional","affiliation":[{"name":"Department of Health Technology, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Draisci","sequence":"additional","affiliation":[{"name":"Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.bja.2019.01.013","article-title":"Perioperative Quality Initiative Consensus Statement on Intraoperative Blood Pressure, Risk and Outcomes for Elective Surgery","volume":"122","author":"Sessler","year":"2019","journal-title":"Br. J. 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