Improved hospital discharge and cost savings with esophageal cooling during left atrial ablation.
Improved hospital discharge and cost savings with esophageal cooling during left atrial ablation.
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DOI：
10.1080/13696998.2022.2160596
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发表时间：
2023-01
影响因子：
2.4
通讯作者：
Daniels, James
中科院分区：
文献类型：
--
作者：
Joseph, Christopher;Cooper, Julie;Sikka, Rishi;Zagrodzky, Jason;Turer, Robert W. W.;McDonald, Samuel A. A.;Kulstad, Erik;Daniels, James
关键词：
左房消融获得肺静脉隔离(PVI)以治疗房颤(AF)是一项技术密集型手术，利用创新和不断改进的技术。用于变坡点的技术的变化反过来会导致程序成本的变化。由于食道靠近左心房后壁，在消融过程中，各种技术被用来保护心脏免受热损伤。在消融期间使用不同的食道保护技术对PVI消融期间的医院费用的影响以前还没有被评估过。目的：比较左房消融术中主动食道降温与管腔食道温度监测的成本。我们进行了基于时间的作业成本计算(TDABC)分析，以确定PVI程序的成本。利用已发表的数据和文献综述来确定使用不同食道保护技术的手术时间和当天出院率的差异，并确定PVI手术后当天出院与过夜住院的成本影响。然后将使用主动食道冷却的病例和使用LET监测的病例的总成本进行比较。实施主动食道冷却的效果与平均总手术时间减少24.7%，当日出血率增加18%相关。TDABC分析发现，在计入食道冷却装置的成本后，与使用主动食道冷却相关的手术成本减少了681美元。考虑到当天排污量增加18%，每个程序节省的成本增加了2135美元。与传统的LET监测相比，即使考虑到冷却装置的额外成本，使用主动食道冷却仍可显著节省成本。这些节省来自于每个患者程序时间的节省和每个人口当天出院率的改善。
Left atrial ablation to obtain pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is a technologically intensive procedure utilizing innovative and continually improving technology. Changes in the technology utilized for PVI can in turn lead to changes in procedure costs. Because of the proximity of the esophagus to the posterior wall of the left atrium, various technologies have been utilized to protect against thermal injury during ablation. The impact on hospital costs during PVI ablation from utilization of different technologies for esophageal protection during ablation has not previously been evaluated. To compare the costs of active esophageal cooling to luminal esophageal temperature (LET) monitoring during left atrial ablation. We performed a time-driven activity-based costing (TDABC) analysis to determine costs for PVI procedures. Published data and literature review were utilized to determine differences in procedure time and same-day discharge rates using different esophageal protection technologies and to determine the cost impacts of same-day discharge versus overnight hospitalization after PVI procedures. The total costs were then compared between cases using active esophageal cooling to those using LET monitoring. The effect of implementing active esophageal cooling was associated with up to a 24.7% reduction in mean total procedure time, and an 18% increase in same-day discharge rate. TDABC analysis identified a $681 reduction in procedure costs associated with the use of active esophageal cooling after including the cost of the esophageal cooling device. Factoring in the 18% increase in same-day discharge resulted in an increased cost savings of $2,135 per procedure. The use of active esophageal cooling is associated with significant cost-savings when compared to traditional LET monitoring, even after accounting for the additional cost of the cooling device. These savings originate from a per-patient procedural time savings and a per-population improvement in same-day discharge rate.
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影响因子：
--
作者：
Fang CJ;Mazzocco JC;Sun DC;Shaker JM;Talmo CT;Mattingly DA;Smith EL
通讯作者：
Smith EL
影响因子：
4.5
作者：
Husereau, Don;Drummond, Michael;Staniszewska, Sophie
通讯作者：
Staniszewska, Sophie
DOI：
10.1056/nejmp2212526
发表时间：
2022-10-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Antman, Elliott M;Leopold, Jane A;Zei, Paul C
通讯作者：
Zei, Paul C
影响因子：
3.1
作者：
Cooper, Julie;Joseph, Christopher;Zagrodzky, Jason;Woods, Christopher;Metzl, Mark;Turer, Robert W.;McDonald, Samuel A.;Kulstad, Erik;Daniels, James
通讯作者：
Daniels, James
影响因子：
2.8
作者：
Colilla, Susan;Crow, Ann;Liu, Xianchen
通讯作者：
Liu, Xianchen