RESUMO
OBJECTIVE: To study the impact on postoperative costs of a patient's antithrombin levels associated with outcomes after cardiac surgery with extracorporeal circulation. DESIGN: An analytic decision model was designed to estimate costs and clinical outcomes after cardiac surgery in a typical patient with low antithrombin levels (<63.7%) compared with a patient with normal antithrombin levels (≥63.7%). The data used in the model were obtained from a literature review and subsequently validated by a panel of experts in cardiothoracic anesthesiology. SETTING: Multi-institutional (14 Spanish hospitals). PARTICIPANTS: Consultant anesthesiologists. MEASUREMENTS AND MAIN RESULTS: A sensitivity analysis of extreme scenarios was carried out to assess the impact of the major variables in the model results. The average cost per patient was 18,772 for a typical patient with low antithrombin levels and 13,881 for a typical patient with normal antithrombin levels. The difference in cost was due mainly to the longer hospital stay of a patient with low antithrombin levels compared with a patient with normal levels (13 v 10 days, respectively, representing a 4,596 higher cost) rather than to costs related to the management of postoperative complications (215, mostly owing to transfusions). Sensitivity analysis showed a high variability range of approximately ±55% of the base case cost between the minimum and maximum scenarios, with the hospital stay contributing more significantly to the variation. CONCLUSIONS: Based on this analytic decision model, there could be a marked increase in the postoperative costs of patients with low antithrombin activity levels at the end of cardiac surgery, mainly ascribed to a longer hospitalization.
Assuntos
Antitrombinas/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/economia , Circulação Extracorpórea/efeitos adversos , Circulação Extracorpórea/economia , Cuidados Pós-Operatórios/economia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/economia , Fibrilação Atrial/etiologia , Transfusão de Sangue/economia , Cardiotônicos/economia , Cardiotônicos/uso terapêutico , Custos e Análise de Custo , Árvores de Decisões , Custos de Medicamentos , Tratamento Farmacológico/economia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Unidades de Terapia Intensiva/economia , Nefropatias/diagnóstico , Nefropatias/economia , Nefropatias/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/economia , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Espanha/epidemiologia , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/etiologia , Inquéritos e Questionários , Tromboembolia/diagnóstico , Tromboembolia/economia , Tromboembolia/etiologia , Resultado do TratamentoAssuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Tamponamento Cardíaco/etiologia , Gerenciamento Clínico , Humanos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , UltrassonografiaAssuntos
Anestesia , Procedimentos Cirúrgicos Cardíacos , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Vértebras Torácicas , Toracotomia , Adulto , Analgesia Epidural , Ponte Cardiopulmonar , Comunicação Interatrial/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
Diagnosis of cardiac neoplasm has become more feasible with the use of echocardiography, but imaging is sometimes not enough to establish a diagnosis, and a biopsy is required to determine the diagnosis and treatment. Transesophageal echocardiography-directed biopsies via a minithoracotomy revealed an extremely rare primary cardiac tumor, a poorly differentiated neuroendocrine carcinoma, in the left atrium of a 54-year-old man who presented with syncope and hypotension.