RESUMEN
OBJECTIVE/BACKGROUND: Heparin coating has recently been shown to reduce the risk of graft failure in arterial revascularisation, at least transiently. The aim of this study was to assess the cost-effectiveness of heparin coated versus standard polytetrafluoroethylene grafts for bypass surgery in peripheral artery disease from a long-term healthcare system perspective. METHODS: Cost-effectiveness evaluation was conducted alongside the Danish part of the Scandinavian Propaten trial in which 431 patients planned for femoro-femoral or femoro-popliteal bypass surgery were randomised to either type of graft and followed for 5 years. Based on the intention to treat principle, the differences in healthcare costs (general practice, prescription medication, hospital admission, rehabilitation, and long-term care in 2015 Euros), life years (LYs), and quality adjusted life years (QALYs) were analysed as arithmetic means with bootstrapped 95% confidence intervals. Cost-effectiveness acceptability curves were used to illustrate the probability of cost-effectiveness for a range of threshold values of willingness to pay (WTP). RESULTS: No statistically significant differences between the randomisation groups were observed for costs or gains of LYs or QALYs. The average cost per QALY was estimated at 10,792. For a WTP threshold of 40,000 per QALY, the overall probability of cost-effectiveness was estimated at 62%, but owing to cost savings in patients with critical ischaemia (cost per QALY <0), it increased to 89% for this subgroup. CONCLUSION: Until further evidence, heparin coated grafts appear overall, to be cost-effective over standard grafts, but important heterogeneity between claudication and critical ischaemia should be noted. While the optimal choice for claudication remains uncertain, heparin coated grafts should be used for critical ischaemia.
Asunto(s)
Anticoagulantes/administración & dosificación , Anticoagulantes/economía , Implantación de Prótesis Vascular/economía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular/economía , Materiales Biocompatibles Revestidos/economía , Arteria Femoral/cirugía , Costos de la Atención en Salud , Heparina/administración & dosificación , Heparina/economía , Enfermedad Arterial Periférica/economía , Enfermedad Arterial Periférica/cirugía , Arteria Poplítea/cirugía , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Ahorro de Costo , Análisis Costo-Beneficio , Dinamarca , Femenino , Heparina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Politetrafluoroetileno/economía , Diseño de Prótesis , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Stapedotomy is a common treatment for conductive hearing loss in otosclerosis patients. AIMS/OBJECTIVES: Results of stapedotomy were assessed in terms of hearing improvement and risk of complications. Potential prognostic factors affecting outcomes were identified. MATERIAL AND METHODS: Retrospectively, 93 stapedotomies were evaluated. The primary outcome was hearing improvement based on postoperative ABG ≤10 dB, Belfast rule of thumb, and AC gain ≥20 dB. Secondary outcomes were postoperative complications. Additionally, prognostic factors potentially affecting outcomes were analyzed (age, gender, comorbidity, preoperative audiometry, tinnitus, or vertigo). RESULTS: A mean ABG of ≤10 dB was achieved in 59%. According to the Belfast rule of thumb, 75% achieved interaural symmetry within ≤15 dB and/or a mean AC4 of ≤30 dB. A gain in AC4 of ≥20 dB was achieved in 57% of primary surgeries. The larger the preoperative ABG, the better hearing after surgery. There was no significant difference in hearing improvement at early and late follow-ups. Transient vertigo was the most common complaint (37%). Taste disturbances were the most frequent permanent complication (14%). CONCLUSION AND SIGNIFICANCE: Stapedotomy gave good audible improvement with a low risk of complications. Preoperative ABG was the only prognostic factor affecting the hearing outcome. Only one follow-up 6-12 months seems relevant.
èæ¯ï¼é«éª¨åå¼æ¯æ¯è³ç¡¬åçæ£è ä¼ å¯¼æ§å¬åæ失ç常è§æ²»çæ¹æ³ãç®çï¼æ ¹æ®å¬åæ¹åå并åçé£é©è¯ä¼°é«éª¨åå¼æ¯çç»æã ç¡®å®å½±åç»æçæ½å¨é¢åå ç´ ãææåæ¹æ³ï¼å顾æ§è¯ä¼°äº 93 ä¾é«éª¨åé¤æ¯ã 主è¦ç»ææ¯å¬åæ¹å, åºäºæ¯å ABG ≤10dBãè´å°æ³æ¯ç¹ç»éªæ³åå AC å¢ç ≥20dBã次è¦ç»ææ¯æ¯å并åçã æ¤å¤, åæäºå¯è½å½±åç»æçé¢åå ç´ ï¼å¹´é¾ãæ§å«ãå并çãæ¯åå¬åæ£æ¥ãè³é¸£æç©æï¼ãç»æï¼59% çæ£è åå¾å¹³å ABG ≤10dBã æ ¹æ®è´å°æ³æ¯ç¹ç»éªæ³å, 75% çæ£è å®ç° ≤15dB 以å çè³é´å¯¹ç§°æ§å/æå¹³å AC4≤30dBã 57% çå次ææ¯å®ç°AC4 çå¢ç≥20dB ã æ¯åABGè¶å¤§, æ¯åå¬åè¶å¥½ãæ©æåææé访æ¶çå¬åæ¹å没ææ¾èå·®å¼ã çæçç©ææ¯æ常è§ç主è¯ï¼37%ï¼ã å³è§éç¢æ¯æ常è§çæ°¸ä¹ æ§å¹¶åçï¼14%ï¼ãç»è®ºåæä¹ï¼é«éª¨åå¼æ¯å¸¦æ¥äºè¯å¥½çå¬è§æ¹å, ä¸å¹¶åçé£é©è¾ä½ã æ¯å ABG æ¯å½±åå¬åç»æçå¯ä¸é¢åå ç´ ã ä» ä¸æ¬¡6-12 个æçé访似ä¹æ¯ç¸å ³çã.
Asunto(s)
Otosclerosis , Cirugía del Estribo , Humanos , Otosclerosis/cirugía , Pronóstico , Estudios Retrospectivos , Cirugía del Estribo/métodos , Audición , Vértigo/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Red blood cell (RBC) transfusions are associated with increased mortality and morbidity. The aim of this analysis was to examine the association between RBC transfusions and long-term survival for patients undergoing elective open infrarenal abdominal aortic aneurysm (AAA) repair with up to 15 years of follow-up. METHODS: Prospective cohort study using data from The Danish Vascular Registry from 2000-2015. Primary endpoint was all-cause mortality. Secondary endpoints were in-hospital complications. Transfused patients were divided into subgroups based on received RBC transfusions (1, 2-3, 4-5 or > 5). Using Cox regression multi-adjusted analysis, non-transfused patients were compared to transfused patients (1, 2-3, 4-5, >5 transfusions) for both primary and secondary endpoints. RESULTS: There were 3 876 patients included with a mean survival of 9.1 years. There were 801 patients who did not receive transfusions. Overall 30-day mortality was 3.1% (121 patients) and 3.6% (112) for all transfused patients. For the five subgroups 30-day mortality was: No transfusions 1.1% (9 patients), 1 RBC 1.2% (4 patients), 2-3 RBC 2.2% (26 patients), 4-5 RBC 1.9% (14 patients) and > 5 RBC 7.9% (68 patients). After receiving RBCs, the hazard ratio for death was 1.54 (95% CI 1.27-1.85) compared to non-transfused patients. There was a significant increase in mortality when receiving 2-3 RBC: HR 1.32 (95% CI 1.07-1.62), 4-5 RBC: 1.64 (1.32-2.03) and >5 RBC: 1.96 (1.27-1.85) in a multi-adjusted model. CONCLUSION: There is a dose-dependent association between RBC transfusions received during elective AAA repair and an increase in short- and long-term mortality. Approximately 25% of included patients had preoperative anemia. These findings should raise awareness regarding potentially unnecessary and harmful RBC transfusions.