RESUMO
A retrospective review of hospital charges was performed in children > 1 year old with native coarctation of the aorta who underwent balloon angioplasty, primary surgical repair, or elective surgical repair after unsuccessful balloon angioplasty. Hospital charges were less overall in the balloon angioplasty group, although the failure rate was higher.
Assuntos
Angioplastia com Balão/economia , Coartação Aórtica/economia , Coartação Aórtica/terapia , Preços Hospitalares , Adolescente , Coartação Aórtica/etiologia , Coartação Aórtica/fisiopatologia , Coartação Aórtica/cirurgia , Pressão Sanguínea , Criança , Pré-Escolar , Humanos , Lactente , Tempo de Internação , Procedimentos Cirúrgicos Vasculares/economiaRESUMO
We performed a prospective, randomized, placebo-controlled, double-blind trial to assess the efficacy of aprotinin in 61 children (median age 3.7 yr) undergoing reoperative open heart surgery (OHS). Three demographically similar groups were studied: large-dose aprotinin (ALD), small-dose aprotinin (ASD), and placebo (P). Over the first 24 postoperative hours fewer patients in the aprotinin groups received packed red cells (ALD, 53%; ASD, 89%; and P, 95%; P = 0.001), platelets (ALD, 32%; ASD, 50%; and P, 65%; P = 0.04), and fresh frozen plasma (ALD, 16%; ASD, 17%; and P, 60%; P = 0.003) than placebo patients. Most importantly, aprotinin patients had fewer exposures to banked blood components (ALD, median 1 U; and ASD, median 2 U) than P (median 6 U; P = 0.001), with no difference in overall complication rate. Use of aprotinin was associated with a savings in the patient charges for blood components, operating room time, and duration of hospitalization. In conclusion, aprotinin decreased the number of units of banked blood components used during the first 24 postoperative hours in reoperative pediatric OHS. Aprotinin thus decreases the risks associated with exposure to banked blood components and reduces hospital charges.
Assuntos
Aprotinina/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Hemostáticos/uso terapêutico , Aprotinina/administração & dosagem , Aprotinina/economia , Procedimentos Cirúrgicos Cardíacos/economia , Criança , Pré-Escolar , Redução de Custos , Análise Custo-Benefício , Método Duplo-Cego , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/economia , Feminino , Hemostáticos/administração & dosagem , Hemostáticos/economia , Preços Hospitalares , Hospitalização , Humanos , Lactente , Tempo de Internação , Masculino , Salas Cirúrgicas/economia , Placebos , Plasma , Transfusão de Plaquetas/efeitos adversos , Transfusão de Plaquetas/economia , Complicações Pós-Operatórias , Estudos Prospectivos , Reoperação , Fatores de Risco , Fatores de TempoRESUMO
Hospital charges for coil occlusion were significantly less than for surgical closure of patent ductus arteriosus, and were reduced over time as experience permitted refinement of the coil occlusion protocol. The expected hospital charges for closure by a coil occlusion strategy, including the charges for surgical closure in patients with failed coil occlusion, was less than the hospital charges for surgical closure strategy under any reasonable estimate of coil occlusion efficacy.
