Safety and cost-effectiveness of MIDCABG in high-risk CABG patients
| Autor: | Nemish D Desai, Dario F Del Rizzo, W.Douglas Boyd, Richard J. Novick, F.Neil McKenzie, Alan H. Menkis |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Framingham Risk Score Ejection fraction business.industry Cost effectiveness medicine.medical_treatment medicine.disease Revascularization Intensive care unit law.invention law Heart failure Internal medicine medicine Cardiopulmonary bypass Cardiology Surgery Cardiology and Cardiovascular Medicine business Survival rate |
| Zdroj: | The Annals of Thoracic Surgery. 66:1002-1007 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/s0003-4975(98)00660-2 |
| Popis: | Background . Myocardial revascularization without cardiopulmonary bypass has been proposed as a potential therapeutic alternative in high-risk patients undergoing coronary artery bypass grafting. To evaluate this possibility we compared 15 high-risk (HR) patients in whom minimally invasive direct coronary artery bypass grafting was used as the method of revascularization with 41 consecutive patients who underwent conventional coronary artery bypass grafting during 1 month. Methods . Patients undergoing myocardial revascularization without cardiopulmonary bypass were significantly older than their low-risk (LR) counterparts (72.2 ± 11.6 versus 63.3 ± 9.7 years, p = 0.006). The demographic profile for HR versus LR patients was as follows: female patients, 60.0% versus 26.8%, p = 0.02; diabetes, 20.0% versus 24.4%, p = 0.7; prior stroke, 33.3% versus 7.4%, p = 0.03; chronic obstructive pulmonary disease, 60.0% versus 9.8%, p p = 0.03, congestive heart failure, 26.6% versus 9.8%, p = 0.09; impaired left ventricular (ejection fraction p = 0.07; urgent operation, 86.6% versus 46.3%, p p = 0.003. Results . There were no deaths in the HR group and one death in the LR group. The average intensive care unit stay was 1.1 ± 0.5 days in HR patients versus 1.6 ± 1.6 days in LR individuals ( p = 0.2), and the average hospital stay was 6.1 ± 1.8 versus 7.3 ± 4.4 days, respectively ( p = 0.3). We used an acuity risk score index developed by the Adult Cardiac Care Network of Ontario to predict outcome in the HR group. The expected intensive care unit stay in HR patients was 4.1 ± 1.2 days (versus the observed stay of 1.1 ± 0.5 days, p p p = 0.3. A cost regression model was used to examine predicted versus actual cost (in Canadian dollars) for the HR patient cohort (based on Ontario Ministry of Health funding). The expected cost for the HR cohort would have been $11,997 per patient. In contrast, the average cost for these 15 patients was $5,997 per patient, an estimated cost saving of 50%. Conclusions . Myocardial revascularization without cardiopulmonary bypass appears to be a safe and cost-effective therapeutic modality for HR patients requiring myocardial revascularization. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|