ABSTRACT
OBJECTIVES: Surgical site infections (SSIs) after bypass procedures provoke major costs. The aim of this prospective randomised trial was to assess if preoperative duplex vein mapping (DVM) reduces costs generated by SSI. MATERIALS/METHODS: Patients undergoing primary infrainguinal bypass were randomised to DVM of the ipsilateral greater saphenous vein (group A) or none (group B). Costs were calculated by the hospital's accounting department. RESULTS: From December 2009 to April 2011, 130 patients (65 each group) were enrolled. Both cohorts were equal regarding demographics, risk factors and costs for primary bypass surgery, respectively. SSIs were classified minor (A: n = 13 vs. B: n = 13, P = n.s.) and major (A: n = 1 vs. B: n = 12, P = .0154). Preoperative DVM was the only significant factor to prevent major SSI (P = .011). Theatre costs for SSI: A: 537 versus B 6553 (P = .16). Recovery room/intensive care unit (ICU) costs for SSI: A: 0 versus B: 8016 (P = .22). Surgical ward costs for SSI: A: 2823 versus B: 22 386 (P = .011). Costs for outpatient visits due to SSI: A: 6265 versus B: 12 831 (P = .67). Total costs of patients without SSI: 8177 versus major SSI: 10 963 (P < .001). CONCLUSION: DVM significantly reduces costs generated by re-admission in patients suffering from major SSI.
Subject(s)
Blood Vessel Prosthesis Implantation/economics , Ischemia/diagnostic imaging , Saphenous Vein/diagnostic imaging , Surgical Wound Infection/economics , Ultrasonography, Doppler, Duplex , Aged , Costs and Cost Analysis , Echocardiography, Doppler, Color , Female , Humans , Intermittent Claudication/diagnostic imaging , Intermittent Claudication/surgery , Ischemia/surgery , Lower Extremity , Male , Preoperative Care , Prospective StudiesABSTRACT
The burden of pneumococcal carriage is largest in developing countries from which, however, detailed studies on pneumococcal transmission are missing. In this study we followed nasopharyngeal carriage in Bangladeshi infants (n=99) from birth, with 2-week sampling intervals until age 4 months, and monthly thereafter until age 1 year, and also their family members at the same intervals. We assessed the dependence of pneumococcal acquisition rates on age, serotype, serotype-specific exposure (i.e. transmission) and current state of carriage (yes/no). A statistical model of pneumococcal transmission, taking into account incompletely observed data, was applied to estimate rates of acquisition and clearance for a large number of serotypes at the same time. Serotypes that were common in the study population were more often acquired from the community than rarer serotypes. However, when conditioning on serotype-specific exposure within the family, transmission rates were similar between different serotypes. Exposure within families signified more than tenfold increase in the rate of acquisition.
