Valvular patients; post operative course, size of the left atrium can predict the cost effectiveness

ABSTRACT

Cost effectiveness in any surgical procedure is a major contributory factor in the continuation of medical services in developing countries. Limited data is available in assessing the factors related with the duration of ICU stay and treatment after valvular replacement surgeries. Our aim was to see the correlation of pre operative Left Atrial size of the patient and duration of post operative stay in ICU. Observational Study. March 2010 to April 2014. Faisalabad Institute of Cardialogoy, Faisalabad. A total of 550 consecutive patients with valvular lesions were included in the study. Their Left Atrial size was measured echocardiographically pre-operatively and their stay /course in the ICU was monitored. Three categories were identified in regard with the Left Atrial size and the ICU stay. If LA size is below 60 cm2, the post operative course and stay in ICU is normal and lasts for about 1-2 days. If LA size is between 60-65 mm2, the post operative course may be complicated and prolonged by the atrial fibrillation / flutter for which pharmacological cardio version may be needed and the stay in ICU is prolonged and may last for about 2-3 days. And if pre-operative LA size is more the 65 mm2 the patient may behave in entirely different way. His atrial fibrillation persists in spite of electro cardiovertion or pharmacological cardiovertion and his stay in ICU may last up to 4-5 days and thus the cost of treatment is raised. LA size can predict the post operative behavior of the patient in ICU and duration of stay and expected cost of the treatment. Smaller is the size of LA, shorter is the stay in ICU and thus lesser is the post operative cost and vice versa