Postoperative Costs Associated With Outcomes After Cardiac Surgery With Extracorporeal Circulation: Role of Antithrombin Levels
Por:
Muedra, V, Llau, JV, Llagunes, J, Paniagua, P, Veiras, S, Fernandez-Lopez, AR, Diago, C, Hidalgo, F, Gil, J, Valino, C, Moret, E, Gomez, L, Pajares, A, de Prada, B
Publicada:
1 abr 2013
Resumen:
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 (sic)18,772 for a typical patient with low antithrombin levels and (sic)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 (sic)4,596 higher cost) rather than to costs related to the management of postoperative complications ((sic)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. (C) 2013 Elsevier Inc. All rights reserved.
Filiaciones:
Muedra, V:
Hosp Univ La Ribera, Serv Anestesia Cuidados Crit & Terapia Dolor, Valencia 46600, Spain
Llau, JV:
Hosp Clin Univ, Serv Anestesiol & Reanimac, Valencia, Spain
Llagunes, J:
Consorcio Hosp Gen Univ Valencia, Serv Anestesiol Cuidados Crit & Med Dolor, Valencia, Spain
Paniagua, P:
Hosp Santa Creu & Sant Pau, Serv Anestesia, Barcelona, Spain
Veiras, S:
Hosp Clin Univ, Serv Anestesia Reanimac & Terapia Dolor, Santiago De Compostela, Spain
Fernandez-Lopez, AR:
Hosp Univ Virgen Macarena, Dept Anestesiol & Reanimac, Seville, Spain
Diago, C:
Hosp Univ Marques de Valdecilla, Serv Anestesiol & Reanimac, Santander, Spain
Hidalgo, F:
Univ Navarra Clin, Dept Anestesia, Pamplona, Navarre, Spain
Gil, J:
Hosp Univ Miguel Servet, Serv Anestesia Reanimac & Tratamiento Dolor, Zaragoza, Spain
Valino, C:
Hosp Mexoeiro, Serv Anestesiol & Reanimac, Pontevedra, Spain
Moret, E:
Hosp Badalona Germans Trias & Pujol, Serv Anestesiol & Reanimac, Barcelona, Spain
Gomez, L:
Hosp Univ Virgen del Rocio, Serv Anestesiol & Reanimac, Seville, Spain
Pajares, A:
Hosp Univ & Politecn La Fe, Serv Anestesiol & Reanimac, Valencia, Spain
de Prada, B:
Hosp Leon, Serv Anestesiol & Reanimac, Leon, Spain
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