Choice of anesthesia technique is associated with earlier hospital discharge and reduced costs after transcatheter transfemoral aortic valve implantation.

Background: Transcatheter aortic valve implantation (TAVI) has become a viable alternative to palliation in patients with severe aortic stenosis. We compared general anesthesia to conscious sedation for TAVI procedures with respect to post operative morbidity, hospital length of stay, and financial burden. Methods: We conducted a retrospective review of prospectively collected data in patients undergoing transfemoral TAVI procedures from 2012 to 2017. Patients were matched based on age and sex and classed into either general anesthesia or conscious sedation groups respectively. Conscious sedation was provided with a dexmedetomidine infusion, and patients in general anesthesia group received a standard induction, tracheal intubation, and maintenance with sevoflurane. The hospital case costs were compared between the two groups before and after adjustment for inflation. Results: We matched 124 pairs for a total of 248 patients. Both groups were similar with respect to demographic data, past medical history, medications, and intraoperative characteristics. There was no difference in postoperative morbidity and mortality between the two groups. The median hospital length of stay was 5 [interquartile range (IQR): 3, 10] and 7 (IQR: 4, 12) days, P=0.01, and after adjustment for inflation, the total hospital case costs were $48,984 (IQR: $44,802, $61,438) Canadian (CAD) vs. $55,333 (IQR: $46,832, $68,702) CAD, P=0.01, in the conscious sedation and general anesthesia groups, respectively. Conclusions: Advancements in TAVI technologies, conscious sedation and a collaborative, multidisciplinary team approach reduces overall length of hospital stay and procedure costs.

The 2019 neuro-rehabilitation implementation framework in Ireland: Challenges for implementation and the implications for people with brain injuries.

In 2019, eight years after the publication of Ireland's first neuro-rehabilitation strategy, an implementation framework was published. This paper describes and assesses the Irish health policy journey to the publication of the 2019 Implementation Framework with a particular focus on tracking the rehabilitation needs of people with acquired brain injury (ABI). Internationally, rehabilitation services are a low priority for governments, with policy makers having limited knowledge and understanding of rehabilitation. This low political priority and policy understanding contributes to under-developed and poorly co-ordinated services for people who need neuro-rehabilitation services, including people with Acquired Brain Injury (ABI). Despite the publication of the 2019 neuro-rehabilitation implementation framework, key challenges remain for people with ABI in Ireland, including the absence of services across the 'pathway', the under-resourcing of specialist rehabilitation services, the impact on the lives of people with brain injury of poor or no access to services, and the lack of good data on this population. The paper concludes with recommendations on how increased political priority of the rehabilitation needs of people with ABI could enhance implementation of the neuro-rehabilitation implementation framework.