Cost Savings Analysis of Early Extubation Following Congenital Heart Surgery
Cost Savings Analysis of Early Extubation Following Congenital Heart Surgery
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DOI：
10.1007/s00246-018-1970-0
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发表时间：
2019-01-01
影响因子：
1.6
通讯作者：
Harris, K. C.
中科院分区：
文献类型：
--
作者：
Holowachuk, S.;Zhang, W.;Harris, K. C.
先天性心脏病手术后早期拔管的临床益处已得到证实，但其对资源利用的影响尚未得到严格评估。我们试图确定对接受先天性心脏病手术的儿童实施早期拔管途径的成本节约。我们对在不列颠哥伦比亚省儿童医院（BCCH）接受先天性心脏病手术的儿童实施早期拔管策略后2.5年内的成本节约进行了分析。所有接受8例胸外科医师协会（STS）基准手术、ASD修复术或双向腔静脉吻合术之一的患者均纳入分析（n=370）。我们将我们的数据与来自当代队列的STS多机构数据进行了比较。我们使用管理数据库估算了ICU护理、病房护理、药物、成像、附加程序和联合医疗保健的每日费用。估计了直接成本、间接成本和成本节约。使用模拟方法、Monte Carlo和bootstrapping计算所有估计值的95%可信区间。每例手术的平均成本节约为12，976美元，BCCH研究期间的总成本节约估计为480万美元，直接成本占成本节约的91%。敏感性分析表明，每例手术的平均成本节约范围为11，934 - 14，059美元。早期拔管与由于减少医院资源利用而节省的大量费用有关。先天性心脏病手术后实施早期拔管策略可能有助于提高资源利用率。
The clinical benefit of early extubation following congenital heart surgery has been demonstrated; however, its effect on resource utilization has not been rigorously evaluated. We sought to determine the cost savings of implementing an early extubation pathway for children undergoing surgery for congenital heart disease. We performed a cost savings analysis after implementation of an early extubation strategy among children undergoing congenital heart surgery at British Columbia Children's Hospital (BCCH) over a 2.5-year period. All patients undergoing one of the eight Society of Thoracic Surgeons (STS) benchmark operations, ASD repair, or bidirectional cavopulmonary anastomosis were included in the analysis (n=370). We compared our data to aggregate STS multi-institutional data from a contemporary cohort. We estimated daily costs for ICU care, ward care, medications, imaging, additional procedures, and allied health care using an administrative database. Direct costs, indirect costs, and cost savings were estimated. Simulation methods, Monte Carlo, and bootstrapping were used to calculate the 95% credible intervals for all estimates. The mean cost savings per procedure was $12,976 and the total estimated cost savings over the study period at BCCH was $4.8million with direct costs accounting for 91% of cost savings. Sensitivity analysis demonstrated a mean cost savings range of $11,934-$14,059 per procedure. Early extubation is associated with substantial cost savings due to reduced hospital resource utilization. Implementation of an early extubation strategy following congenital heart surgery may contribute to improved resource utilization.