Excess costs associated with common healthcare-associated infections in an Iranian cardiac surgical unit.

Healthcare-associated infection (HCAI) following open heart surgery is not only a major cause of mortality and morbidity, but also carries higher costs. There are limited data on the additional costs due to HCAI in non-western countries. To estimate the direct cost of the four most common HCAIs in an Iranian sample, we studied 1191 patients admitted for elective open heart surgery. HCAIs were defined using the National Nosocomial Infections Surveillance criteria (Centers for Disease Control and Prevention, Atlanta, GA, USA). The financial costs of length of stay per day in hospital, paraclinical services, medications, instruments, and operating room were provided by the hospital's finance department. The contribution of HCAI to excess direct medical costs in patients with HCAI was assessed by multivariable linear regression. In the study population, the mean age was 57.3±11.9 years, 857 (72.0%) were men, and 64 (5.4%) developed HCAI. In total there were 73 infections of which the most common was surgical site infection (49.3%), followed by urinary tract infection (20.5%), bloodstream infection (16.5%), and pneumonia (13.7%). After adjustment for other confounders HCAI remained associated with excess direct medical costs (ß=1707.06, SE=90.84; P < 0.001). The medical costs in patients with HCAI were almost twice those in patients without HCAI. More than half of the excess cost was attributable to prolonged hospitalisation.

Effect of gender and type 2 diabetes mellitus on heart rate recovery in patients with coronary artery disease after cardiac rehabilitation.

AIM: The purpose of this study was to clarify whether type 2 diabetic patients with coronary disease are subject to similar benefits on heart rate recovery (HRR) as non-diabetic coronary individuals after cardiac rehabilitation, assessing separately male and female subjects separately. METHODS: Data used for the analyses were from an eight-week phase II cardiac rehabilitation including 284 patients with ischemic heart disease who were managed at Tehran Heart Center between July 2004 and January 2006. The heart rate parameters were compared between diabetic and non-diabetic subjects before and after cardiac rehabilitation. Diabetic and non-diabetic patients had similar age and left ventricular ejection fraction. RESULTS: Among men, non-diabetic patients achieved greater improvement in peak heart rate and HRR. Additionally, lower resting heart rate was found in non-diabetic men after rehabilitation. In women > or = 50 years, there was no significant difference between diabetic and non-diabetic. The non-diabetic women < 50 years showed significantly higher peak heart rate and HRR compared with diabetics women. CONCLUSION: These results indicate that the benefit of cardiac rehabilitation in HRR is significantly lower in type 2 diabetic men. Improvement of HRR is not associated with diabetic status in women > or = 50 years. The response to cardiac rehabilitation in women may appear to be more influenced by age at menopause rather than diabetes mellitus.