Postoperative atrial fibrillation: evaluation of its economic impact on the costs of cardiac surgery

Abstract Objective: The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital. Methods: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication. Results: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups. Conclusion: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

Postoperative Atrial Fibrillation: Evaluation of its Economic Impact on the Costs of Cardiac Surgery.

OBJECTIVE: The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital. METHODS: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication. RESULTS: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups. CONCLUSION: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

Ex vivo model with bovine heart: a proposal for training microscopic dissection and vascularmicroanastomoses. / Modelo ex-vivo com coração bovino: proposta para treinamento de dissecção microscópica e de microanastomoses vasculares.

Training is a process that requires patience and constant practice. The execution of microscopic procedures is present in the day-to-day of several surgical specialties, but unfortunately experimental models are not easy to access in our environment. We propose a bovine heart model used by residents and young surgeons in the training of microscopic dissection and microanastomoses. It is described the assembly of this model, which can be performed individually and with accessible material to the surgical departments. Our experience in the preparation of the pieces, as well as tips for the process, are described in the text. The bovine myocardial model can be reproduced in any center with benches and surgical instruments. Low cost, fast preparation, and wide availability of the used tissue are among the advantages of this model. We consider the project useful in the training of surgical residents and young surgeons.

O treinamento é um processo que exige paciência e constante prática. A execução de procedimentos microscópicos está presente no dia a dia de diversas especialidades cirúrgicas, mas infelizmente modelos experimentais não são de fácil de acesso. Propomos um modelo com coração bovino usado por residentes e jovens cirurgiões no treinamento de dissecção microscópica e microanastomoses. É descrita a montagem deste modelo, que pode ser realizado de maneira individual e com material acessível aos departamentos cirúrgicos. Nossa experiência na elaboração das peças, assim como, dicas para o processo são descritas no texto. O modelo com miocardio bovino pode ser reproduzido em qualquer centro que disponha de bancadas e instrumental cirúrgico. Dentre as vantagens estão o baixo custo, rápido preparo e grande disponibilidade do tecido utilizado. Consideramos o projeto útil no treinamento de residentes cirúrgicos e jovens cirurgiões.

Resource Use and Morbidities in Pediatric Cardiac Surgery Patients with Genetic Conditions.

OBJECTIVE: To evaluate and describe resource use and perioperative morbidities among those patients with genetic conditions undergoing cardiac surgery. STUDY DESIGN: Using the Pediatric Health Information System database, we identified patients ≤18 years old with cardiac surgery classified by Risk Adjustment for Congenital Heart Surgery (RACHS) during 2003-2014. A total of 95 253 patients met study criteria and included no genetic conditions (84.6%), trisomy 21 (9.9%), trisomy 13 or 18 (0.2%), 22q11 deletion (0.8%), Turner syndrome (0.4%), and "other" genetic conditions (4.2%). We compared perioperative complications and procedures in each genetic condition with patients without genetic conditions using regression analysis. RESULTS: All groups with genetic conditions, excluding trisomy 21 RACHS 3-5, experienced increased length of stay and cost among survivors. Complications varied by genetic condition, with patients with trisomy 21 having increased odds of pulmonary hypertension and nosocomial infections. Patients with 22q11 only had increased odds of infection. Patients with Turner syndrome had increased odds of acute renal failure (OR 2.35). Patients with trisomy 13 or 18 had increased odds of pulmonary hypertension (OR 3.13), acute renal failure (OR 2.93), cardiac arrest (OR 2.84), and nosocomial infections (OR 3.53), and those with "other" genetic conditions had increased odds of all complications. CONCLUSIONS: Children with congenital heart disease and genetic conditions, except trisomy 21 RACHS 3-5, had increased costs and length of stay. Perioperative morbidities were more common and differed across genetic condition subgroups. Patient-specific risk factors are important for risk stratification, benchmarking, and counseling with families.

Modelo ex-vivo com coração bovino: proposta para treinamento de dissecção microscópica e de microanastomoses vasculares / Ex vivo model with bovine heart: a proposal for training microscopic dissection and vascularmicroanastomoses

RESUMO O treinamento é um processo que exige paciência e constante prática. A execução de procedimentos microscópicos está presente no dia a dia de diversas especialidades cirúrgicas, mas infelizmente modelos experimentais não são de fácil de acesso. Propomos um modelo com coração bovino usado por residentes e jovens cirurgiões no treinamento de dissecção microscópica e microanastomoses. É descrita a montagem deste modelo, que pode ser realizado de maneira individual e com material acessível aos departamentos cirúrgicos. Nossa experiência na elaboração das peças, assim como, dicas para o processo são descritas no texto. O modelo com miocardio bovino pode ser reproduzido em qualquer centro que disponha de bancadas e instrumental cirúrgico. Dentre as vantagens estão o baixo custo, rápido preparo e grande disponibilidade do tecido utilizado. Consideramos o projeto útil no treinamento de residentes cirúrgicos e jovens cirurgiões.

ABSTRACT Training is a process that requires patience and constant practice. The execution of microscopic procedures is present in the day-to-day of several surgical specialties, but unfortunately experimental models are not easy to access in our environment. We propose a bovine heart model used by residents and young surgeons in the training of microscopic dissection and microanastomoses. It is described the assembly of this model, which can be performed individually and with accessible material to the surgical departments. Our experience in the preparation of the pieces, as well as tips for the process, are described in the text. The bovine myocardial model can be reproduced in any center with benches and surgical instruments. Low cost, fast preparation, and wide availability of the used tissue are among the advantages of this model. We consider the project useful in the training of surgical residents and young surgeons.

Low cost simulator for heart surgery training

Abstract Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost. Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field. Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

Low Cost Simulator for Heart Surgery Training.

Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost. Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field. Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System / Custos das Cirurgias Cardíacas Segundo o Risco Pré-Operatório no Sistema Público de Saúde Brasileiro

AbstractBackground:Heart surgery has developed with increasing patient complexity.Objective:To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).Method:All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.Results:Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.Conclusion:Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

ResumoFundamentos:A cirurgia cardíaca evoluiu progressivamente com o aumento da complexidade dos pacientes.Objetivo:Avaliar a utilização de recursos e o custo real segundo o grupo de risco dos pacientes submetidos à cirurgia cardíaca, e compará-los com o valor ressarcido pelo Sistema Único de Saúde (SUS).Método:Foram analisadas todas as cirurgias cardíacas realizadas entre janeiro e julho de 2013 em um centro terciário. Dados demográficos e clínicos permitiram o cálculo do valor ressarcido pelo SUS. Os pacientes foram estratificados em baixo, médio e alto risco pelo EuroSCORE. Os resultados clínicos, o uso de recursos e os custos (real versus SUS) foram comparados entre os grupos de risco estabelecidos.Resultados:Taxas de mortalidade pós-operatória de baixo, intermediário e alto risco apresentaram correlação linear positiva (EuroSCORE: 3,8%, 10% e 25%, respectivamente; p < 0,0001), assim como a ocorrência de alguma complicação pós-operatória (EuroSCORE: 13,7%, 20,7% e 30,8%, respectivamente; p = 0,006). O tempo de internação aumentou de 20,9 para 24,8 e 29,2 dias, respectivamente (p < 0,001). O custo real foi paralelo ao aumento da utilização de recursos, segundo o EuroSCORE (R$ 27.116,00 ± R$13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectivamente; p < 0,001). O ressarcimento do SUS também aumentou (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$ 935,00; p < 0,001). Mesmo com aumento do EuroSCORE, houve diferença (p < 0,0001) progressiva entre o incremento do custo real e o ressarcimento do SUS.Conclusão:O aumento do EuroSCORE esteve relacionado a maiores morbimortalidade, tempo de internação e custos no pós-operatório. Embora o ressarcimento do SUS também aumente conforme o risco, ele não é proporcional ao custo real.

Cardiac surgery costs according to the preoperative risk in the Brazilian public health system.

BACKGROUND: Heart surgery has developed with increasing patient complexity. OBJECTIVE: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). METHOD: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. RESULTS: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. CONCLUSION: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

Non-cardiac surgery in developing countries: epidemiological aspects and economical opportunities--the case of Brazil.

BACKGROUND: Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. METHODS AND FINDINGS: This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than $10 billion in all these years. The yearly cost of surgical procedures to public health system was more than $1.27 billion for all surgical hospitalizations, and in average, U$445.24 per surgical procedure. The total cost of blood transfusion was near $98 million in all years and annually approximately $10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r(2)) = 0.447 for the number of surgeries (P = 0.012), r(2) = 0.439 for in-hospital expenses (P = 0.014) and r(2) = 0.907 for surgical mortality (P = 0.0055). CONCLUSION: The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.

[Strategies to reduce the use of blood components in cardiovascular surgery]. / Estratégias para redução do uso de hemoderivados em cirurgia cardiovascular.

OBJECTIVE: The aim of this study is to evaluate the strategies adopted by our team to reduce the use of bloods components in patients undergoing cardiovascular surgical procedures. METHODS: Between October 2005 and January 2007, 101 patients were operated. Fifty-one (50.5%) were male and 50 (49.5%) female. Patients' age ranged from 13 to 80 years (mean of 50.76 years). The strategy consisted in using antifibrinolytics and normovolemic hemodilution, and reinfusion of all the blood remaining in the CPB circuit. RESULTS: Mean use of blood components was 1.45 UI, red blood cells; 0.75 UI, fresh frozen plasma; 0.89 UI, cryoprecipitate, and 1.43 UI, platelet. Fifty-nine patients (58.4%) had not used blood components and 12 (11.9%) patients used more than 4 UI of red blood cells. In 27 patients (26.7%) whose CPB time was higher than 120 minutes, 17 (63%) needed hemotransfusion. However, 3 (2.97%) developed coagulopathy and 2 (1.98%) needed reoperation due to bleeding. Of the three patients who developed coagulopathy, two were in the elderly subgroup. CONCLUSION: In the presented series, the measures adopted succeeded in reducing the need of hemotransfusion in the postoperative period of thoracic surgery. Patients with CPB time higher than 120 minutes tended to need hemotransfusion. The association of surgery in elderly patients and CPB time over 120 minutes resulted in significantly greater use of blood components postoperatively.

Estratégias para redução do uso de hemoderivados em cirurgia cardiovascular / Strategies to reduce the use of blood components in cardiovascular surgery

OBJETIVO: O objetivo deste estudo é avaliar as estratégias adotadas por nossa equipe para reduzir o uso de hemoderivados em pacientes submetidos a cirurgia cardiovascular. MÉTODOS: Entre outubro de 2005 e janeiro de 2007, foram operados 101 pacientes. Destes, 51 (50,5 por cento) eram do sexo masculino e 50 (49,5 por cento) do feminino. A idade variou de 13 a 80 anos (média de 50,76 anos). A estratégia utilizada consiste em uso de antifibrinolíticos, hemodiluição normovolêmica e reposição total do perfusato. RESULTADOS: A média de utilização de hemoderivados por paciente foi de 1,45 UI de CH; 0,75 UI de PF; 0,89 UI de crioprecipitados e 1,43 UI de plaquetas. Em 59 (58,4 por cento) pacientes, não foram usados hemoderivados e somente 12 (11,9 por cento) pacientes necessitaram mais de quatro UI de CH. Dentre os 27 (26,7 por cento) pacientes cujo tempo de circulação extracorpórea (CEC) excedeu os 120 minutos, 17 (63 por cento) necessitaram de hemotransfusão. Apenas três (2,97 por cento) pacientes desenvolveram coagulopatia, sendo dois (1,98 por cento) reoperados por sangramento. Dos três pacientes que desenvolveram coagulopatia, dois pertenciam ao subgrupo de idosos. CONCLUSÃO: Na série apresentada, as medidas adotadas conseguiram reduzir a necessidade de hemotransfusão no pós-operatório de cirurgia cardíaca. Pacientes com tempo de CEC maior que 120 minutos tenderam a necessitar de hemotransfusão. A associação de cirurgia em pacientes idosos e tempo de CEC superior a 120 minutos resultou em maior utilização de sangue e hemoderivados no período pós-operatório.

OBJECTIVE: The aim of this study is to evaluate the strategies adopted by our team to reduce the use of bloods components in patients undergoing cardiovascular surgical procedures. METHODS: Between October 2005 and January 2007, 101 patients were operated. Fifty-one (50.5 percent) were male and 50 (49.5 percent) female. Patients' age ranged from 13 to 80 years (mean of 50.76 years). The strategy consisted in using antifibrinolytics and normovolemic hemodilution, and reinfusion of all the blood remaining in the CPB circuit. RESULTS: Mean use of blood components was 1.45 UI, red blood cells; 0.75 UI, fresh frozen plasma; 0.89 UI, cryoprecipitate, and 1.43 UI, platelet. Fifty-nine patients (58.4 percent) had not used blood components and 12 (11.9 percent) patients used more than 4 UI of red blood cells. In 27 patients (26.7 percent) whose CPB time was higher than 120 minutes, 17 (63 percent) needed hemotransfusion. However, 3 (2.97 percent) developed coagulopathy and 2 (1.98 percent) needed reoperation due to bleeding. Of the three patients who developed coagulopathy, two were in the elderly subgroup. CONCLUSION: In the presented series, the measures adopted succeeded in reducing the need of hemotransfusion in the postoperative period of thoracic surgery. Patients with CPB time higher than 120 minutes tended to need hemotransfusion. The association of surgery in elderly patients and CPB time over 120 minutes resulted in significantly greater use of blood components postoperatively.

Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country.

OBJECTIVES: We compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder (ASO) (AGA Medical Corp., Golden Valley, Minnesota) device compared with surgical closure of an ostium secundum atrial septal defect (ASD II) in Guatemala. BACKGROUND: The percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure. METHODS: We reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures. RESULTS: Eighty-three patients with ASD II (75%) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients (25%) underwent surgical closure. In the device group, in 72 patients (86.7%) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion (U.S. 3,329.50 dollars +/- 411.30 dollars and U.S. 4,521.03 dollars +/- 429.71 dollars; p < 0.001, respectively). Cost of the device (U.S. 2,930.00 dollars) proved to be the main cause for this difference. CONCLUSIONS: We confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compared with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective.

Similar preoperative hemodynamic response to pancuronium and rocuronium in high-risk cardiac surgical patients.

AIM: Rocuronium may be a good alternative to pancuronium in cardiac surgical patients. We evaluate the hemodynamic response to rocuronium and pancuronium administered to cardiac surgical patients. METHODS: A single-blind, randomized clinical trial was carried out at the National Institute of Cardiology in Mexico. Twenty-two patients older than 18 years, NYHA class III-IV, and scheduled to undergo an elective cardiovascular surgical procedure were enrolled. Patients were randomly allocated to receive an i.v. bolus dose of either pancuronium 100 microg/kg or rocuronium 600 microg/kg. Peripheral arterial (radial) and venous cannulations and insertion of a multi-lumen pulmonary artery flotation catheter through the right internal jugular vein were carried out under local anesthesia. Anesthetic induction with an i.v. bolus dose of fentanyl 700 microg and diazepam 20 mg was performed and thereafter the neuromuscular blocking agent was administered. Ventilation with O2 100% was performed until a TOF < or =5% was observed and tracheal intubation was performed. After intubation, patients were maintained with O2 10 mL/kg administered by means of a pulmonary ventilator at a pressure of 20-25 cm H2O. The basal, pre-laryngoscopy, post-intubation, and pre-operative recording of a set of cardiovascular parameters were obtained. RESULTS: No differences (P>0.05) in the hemodynamic response were observed between pancuronium and rocuronium nor during the different evaluation times in each group. CONCLUSIONS: Rocuronium can be a safe alternative to pancuronium for patients requiring cardiac surgical procedures.

Tratamiento de conducto arterioso permeable: Comparación de costos del cierre quirúrgico y transcateterismo en una institución pública / Treatment of patent ductus arteriosus: Comparison of costs between surgical and trans-catheter closures in a public institution

El costo del tratamiento transcateterismo del conducto arterioso permeable en comparación con el quirúrgico es un asunto controvertido en nuestro medio. El propósito de este estudio fue estimar y comparar los costos directos relacionados con ambos procedimientos. Método: Se incluyeron 57 pacientes tratados con intervencionismo y 26 con cirugía. Se obtuvo información sobre las características sociodemográficas, el número y tipo de exámenes de laboratorio y de gabinete, el tipo y duración de anestesia, la duración del procedimiento y la estancia hospitalaria y de terapia intensiva. Se construyó una matriz que integró los costos del sistema institucional de costos unitarios vigente. Resultados: Ambos grupos compartían características sociodemográficas. El diámetro del conducto fue mayor en el grupo quirúrgico (p<0.05). Tanto la estancia hospitalaria como el número de complicaciones post intervención fueron menores en los pacientes tratados con intervencionismo (p<0.05). El tratamiento con dispositivo Amplatzer® es más costoso que el tratamiento quirúrgico y ambos más costosos que el oclusor tipo resorte. En el tratamiento quirúrgico el 86.5% de los costos totales lo consumen la estancia hospitalaria, con el Amplatzer® este rubro fue del 36%, sin embargo el dispositivo representa el 40% del costo total. Conclusiones: No obstante el costo del tratamiento con dispositivo Amplatzer® es mayor que el quirúrgico, el cierre con oclusor representa ventajas con relación a menor estancia hospitalaria, consumo de recursos y número de complicaciones, lo que permite la optimización de los recursos hospitalarios.

The costs of transcatheter closure of patent ductus arteriosus in relation to the surgical closure still a controvertial issue in our hospitals. The aim of the study was compared the costs of both treatments. Methods: We included 57 patients treated with transcatheter occlusion and 26 underwent surgery. Information about laboratory tests, average in hospital days of stay, anesthesia type and duration, operating and hemodinamic room costs, was gather. A database containing the costs from the institution unitary costs system in force was designed. Results: sociodemographyc characteristics were similar in both groups. Ductus size was larger in patients treated with surgery (p<0.05). In hospital stay, as well as, the number of complications after the procedure were less in the patients treated with transcatheter occlusion (p<0.05). The closure with Amplatzer® device was more expensive than the surgical one, and both were more expensive than coil. With surgical treatment, 86.5% of the costs are due to in hospital stay, with the Amplatzer® this issues represented a 36%, however, the cost of the devices by itself represents a 40% of the total treatment cost. Conclusions: Even though total charges of Amplatzer® devices are more expensive than surgery, transcatheter occlusion represents advantages in relation to less in hospital stay, resources used and number of complications, which allows hospital resources optimization.

[Treatment of patent ductus arteriosus. Comparison of costs between surgical and trans-catheter closures in a public institution]. / Tratamiento de conducto arterioso permeable. Comparación de costos del cierre quirúrgico y transcateterismo en una institución pública.

UNLABELLED: The costs of transcatheter closure of patent ductus arteriosus in relation to the surgical closure still a controvertial issue in our hospitals. The aim of the study was compared the costs of both treatments. METHODS: We included 57 patients treated with transcatheter occlusion and 26 underwent surgery. Information about laboratory tests, average in hospital days of stay, anesthesia type and duration, operating and hemodinamic room costs, was gather. A database containing the costs from the institution unitary costs system in force was designed. RESULTS: sociodemographyc characteristics were similar in both groups. Ductus size was larger in patients treated with surgery (p<0.05). In hospital stay, as well as, the number of complications after the procedure were less in the patients treated with transcatheter occlusion (p<0.05). The closure with Amplatzer device was more expensive than the surgical one, and both were more expensive than coil. With surgical treatment, 86.5% of the costs are due to in hospital stay, with the Amplatzer this issues represented a 36%, however, the cost of the devices by itself represents a 40% of the total treatment cost. CONCLUSIONS: Even though total charges of Amplatzer devices are more expensive than surgery, transcatheter occlusion represents advantages in relation to less in hospital stay, resources used and number of complications, which allows hospital resources optimization.