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1.
Ethiop J Health Sci ; 33(6): 1049-1054, 2023 Nov.
Article in English | MEDLINE | ID: mdl-38784489

ABSTRACT

Background: There is only limited data in the literature showing the effect of anesthesia methods on the success of retrograd intrarenal surgery. The aim of this study was to compare and evaluate retrograd intrarenal surgery cases performed under spinal and general anesthesia in terms of effectiveness, cost, hospitalization time and complications. Methods: A total of 337 patients who underwent retrograd intrarenal surgery due to kidney stones between 2014 and 2019 were retrospectively evaluated. In our study, the patients were divided into two groups according to the anesthesia method administered: Group 1 consisted of 172 patients who received spinal anesthesia and Group 2 comprised 165 patients administered general anesthesia. Both groups were compared in terms of demographic data, localization and size of stone, radiographic stone density, operation time, complications, need for postoperative analgesia, length of hospitalization, and stone free rate. Results: The cost of general anesthesia was significantly higher compared to that of spinal anesthesia (p < 0.001). The analgesia application administered within the first six postoperative hours was significantly higher in the general anesthesia group (p < 0.001). In other findings, there was no statistically significant difference between the two groups. Conclusion: Retrograd intrarenal surgery can be performed with similar safety and effectiveness under both general and spinal anesthesia. However, spinal anesthesia seems to be more advantageous due to the patients' lower need for analgesics in the early postoperative period and the lower cost of the anesthetics used.


Subject(s)
Anesthesia, General , Anesthesia, Spinal , Kidney Calculi , Humans , Female , Male , Anesthesia, General/economics , Anesthesia, General/methods , Retrospective Studies , Middle Aged , Kidney Calculi/surgery , Adult , Anesthesia, Spinal/economics , Anesthesia, Spinal/methods , Length of Stay/economics , Length of Stay/statistics & numerical data , Operative Time , Treatment Outcome , Kidney/surgery , Aged
2.
Plast Reconstr Surg ; 149(2): 240e-247e, 2022 Feb 01.
Article in English | MEDLINE | ID: mdl-35077419

ABSTRACT

BACKGROUND: Minimizing expenses attributed to dorsal wrist ganglion cyst excisions, a common minor surgical procedure, presents potential for health care cost savings. Varying the surgical setting (operating room versus procedure room) and type of anesthesia (local-only, monitored anesthesia care, or monitored with regional or general anesthesia) may affect total operative costs. METHODS: Patients who underwent an isolated unilateral dorsal wrist ganglion cyst excision between January of 2014 and October of 2019 at a single academic medical center were identified by CPT code. The total direct costs for each surgical encounter that met inclusion criteria were calculated. The relative total direct costs were compared between surgical setting and anesthesia type groups. Univariate and multivariable gamma regression models were used to identify factors associated with surgical costs. RESULTS: A total of 192 patients were included; 26 cases (14 percent) were performed in the procedure room and 166 cases (86 percent) were performed in the operating room. No significant differences in demographic factors were identified between groups. Univariate analysis demonstrated that use of operating room/monitored anesthesia care, operating room/monitored anesthesia care with regional anesthesia, and operating room/general anesthesia groups, as compared to procedure room/local-only, yielded significantly greater median costs (1.76-, 2.34-, and 2.44-fold greater, respectively). Multivariable analysis demonstrated 1.80-, 2.10-, and 2.31-fold greater costs with use of operating room/monitored anesthesia care, operating room/monitored anesthesia care with regional anesthesia, and operating room/general anesthesia relative to procedure room/local-only, respectively. CONCLUSION: Performing dorsal wrist ganglion cyst excisions in a procedure room with local-only anesthesia minimizes operative direct costs relative to use of the operating room and other anesthetic types.


Subject(s)
Anesthesia, Conduction/economics , Anesthesia, General/economics , Ganglion Cysts/economics , Ganglion Cysts/surgery , Health Care Costs , Wrist , Adult , Female , Humans , Male , Retrospective Studies , Young Adult
5.
Laryngoscope ; 131(3): E946-E951, 2021 03.
Article in English | MEDLINE | ID: mdl-32663339

ABSTRACT

OBJECTIVE: To report the outcomes on a large series of elderly patients who underwent cochlear implantation (CI) surgery under local anesthesia with conscious sedation (LA-CS). METHODS: Retrospective chart review on 100 consecutive elderly patients (> 65 years) who underwent CI with LA-CS at a tertiary care center between August 2013 and January 2020. An age-matched control group of 50 patients who underwent CI with general anesthesia (GA) are used for comparison. Outcomes measured included time in the operating room, time in the postanesthesia care unit (PACU), and rate of adverse events. RESULTS: Cochlear implant surgery under LA-CS was successfully performed in 99 (99%) patients. One patient requiring conversion to GA intraoperatively. No patients in the LA-CS group experienced cardiopulmonary adverse events; however, three patients (6%) in the GA group experienced minor events including atrial fibrillation and/or demand ischemia. Overnight observation in the hospital due to postoperative medical concerns or prolonged wake-up from anesthesia was required in one patient (1%) from the LA-CS cohort and 12 patients (24%) from the GA cohort. Perioperative adverse events exclusive to the LA-CS group included severe intraoperative vertigo (8%), temporary facial nerve paresis (3%), and wound infection (1%). The average amount of time spent in the operating room was 37 minutes less for procedures performed under LA-CS compared to GA (P < .05). The average amount of time in recovery was similar for both groups (P > .05). CONCLUSION: Cochlear implant surgery under LA-CS offers many benefits and is a safe, feasible, and cost-effective alternative to GA when performed by experienced CI surgeons. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E946-E951, 2021.


Subject(s)
Anesthesia, General/adverse effects , Anesthesia, Local/methods , Cochlear Implantation/adverse effects , Conscious Sedation/methods , Postoperative Complications/epidemiology , Administration, Topical , Aged , Aged, 80 and over , Anesthesia, General/economics , Anesthesia, Local/adverse effects , Anesthesia, Local/economics , Conscious Sedation/adverse effects , Conscious Sedation/economics , Cost-Benefit Analysis , Dexmedetomidine/administration & dosage , Feasibility Studies , Female , Humans , Hypnotics and Sedatives/administration & dosage , Infusions, Intravenous , Injections, Subcutaneous , Lidocaine/administration & dosage , Male , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome
8.
Rev Esp Anestesiol Reanim (Engl Ed) ; 67(2): 63-67, 2020 Feb.
Article in English, Spanish | MEDLINE | ID: mdl-31955889

ABSTRACT

INTRODUCTION: Vitrectomy surgery is a common procedure for the treatment of several types of ophthalmologic conditions. It can be performed under regional anaesthesia with peribulbar block (PB) or general anaesthesia (GA). There are no evidence-based recommendations on the optimal anaesthesia strategy for this procedure. The aim of this study was to compare the advantages of PB and GA for vitrectomy surgery. MATERIALS AND METHODS: A prospective observational study was conducted on adults submitted for mechanical vitrectomy between January 2017 and December 2017. Demographic and perioperative data were collected, namely ASA physical status, median arterial pressure, heart rate, postoperative opioid consumption, postoperative nausea and vomiting, times of induction, surgery, recovery, and hospital stay and costs considering medication and material needed. Statistical analysis was performed using SPSS v.25, with chi-square, Fisher and Mann-Whitney U tests, according to the type of variables analysed. RESULTS AND DISCUSSION: We included 179 patients submitted for mechanical vitrectomy: 91 (51%) with PB and 88 (49%) under GA. Patients submitted to PB were older (69.0 vs. 64.5 years, p=.006) and presented with higher ASA physical status (p=.001). For haemodynamic outcomes, patients submitted to PB presented with less variation of median arterial pressure (-3.0 vs. -13.5mmHg, p=.000) and with no significant differences in heart rate (-2.0 vs. -3.0 bpm, p=.825). In the postoperative period, the PB group presented with decreased need of postoperative analgesia (0.0 vs. 5.0, p=.026) and a lower incidence of nausea and vomiting (1.0 vs. 12.0, p=.001). Times related to anaesthesia and surgery were better in PB group, with shorter induction time (10.0 vs. 11.0min, p=.000), surgery time (56.5 vs. 62.0min, p=.001), recovery time (10.0 vs. 75.5min, p=.000), and hospital stay (2.0 vs. 3.0 days, p=.000). When analysing costs, PB was less expensive than GA (4.65 vs. 12.09 euros, p=.021) CONCLUSION: PB is a reliable and safe alternative to GA for patients undergoing mechanical vitrectomy, permitting good anaesthesia and akinesia conditions during surgery, better haemodynamic stability, and less postoperative complications, especially in older patients and those with more comorbidities.


Subject(s)
Anesthesia, General , Nerve Block/methods , Vitrectomy/methods , Age Factors , Aged , Anesthesia Recovery Period , Anesthesia, General/economics , Anesthesia, General/statistics & numerical data , Humans , Length of Stay , Middle Aged , Nerve Block/economics , Nerve Block/statistics & numerical data , Operative Time , Prospective Studies , Vitrectomy/statistics & numerical data
9.
Mymensingh Med J ; 29(1): 136-141, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31915349

ABSTRACT

This study was designed to observe the haemodynamic changes, recovery status and cost effectiveness during anaesthesia in laparoscopic cholecystectomy with medical air in comparison to anaesthesia with nitrous oxide associated with maintain of adequate analgesia and was conducted in the department of Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2017. Nitrous oxide is popularly using as an analgesic in current balanced general anesthesia in addition carrier agent for anesthetic. Intraoperative pain intensity depends on many variables including, type of surgery, surgical stimulation and surgical incision. It is difficult to measure intraoperative pain properly under general anesthesia therefore anesthetist depends on the surrogate marker of inadequate analgesia like raised heart rate, blood pressure, sweating and lacrimation. However, unfortunately, these parameters may changes in same direction with light plane of anesthesia, hypercarbia and ongoing procedural status of the patient.


Subject(s)
Analgesics/administration & dosage , Anesthesia/methods , Cholecystectomy, Laparoscopic/methods , Nitrous Oxide/administration & dosage , Analgesics/economics , Anesthesia Recovery Period , Anesthesia, General/economics , Bangladesh , Cholelithiasis/surgery , Cost-Benefit Analysis , Hemodynamics/drug effects , Humans , Monitoring, Intraoperative , Nitrous Oxide/economics , Postoperative Period
11.
Anaesthesist ; 68(12): 827-835, 2019 12.
Article in German | MEDLINE | ID: mdl-31690960

ABSTRACT

BACKGROUND: The economic effect is a crucial aspect of every medical procedure. This article analyzes the economic implications of various methods in anesthesia based on three case vignettes. METHODS: The management of anesthesia of a forearm fracture with sufficient brachial plexus blockade, general anesthesia and insufficient brachial plexus blockade with subsequent general anesthesia was analyzed with respect to the relevant cost factors (personnel costs, durables, consumables, fixed assets costs, anesthesia-related overhead costs). RESULTS: Sufficient regional anesthesia was the least expensive method for a forearm fracture with 324.26 €, followed by general anesthesia with 399.18 € (+23% compared with regional anesthesia). Insufficient regional anesthesia was most the expensive method, which necessitated an additional general anesthesia (482.55 €, +49% compared with sufficient regional anesthesia). CONCLUSION: Even considering that this cost analysis was calculated based on data from only one medical institution (General Hospital of Vienna, Medical University of Vienna), regional anesthesia appeared to be cost efficient compared with other anesthesia procedures. Main cost drivers in this example were personnel costs.


Subject(s)
Anesthesia, Conduction/economics , Anesthesia, General/economics , Brachial Plexus Block/economics , Costs and Cost Analysis , Humans
12.
Eur Arch Otorhinolaryngol ; 276(11): 2963-2973, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31486936

ABSTRACT

PURPOSE: Office-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings. METHODS: PubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed. RESULTS: Of 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial. CONCLUSION: Office-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia.


Subject(s)
Ambulatory Surgical Procedures/economics , Health Care Costs/statistics & numerical data , Hospitalization/economics , Larynx/surgery , Operating Rooms/economics , Otorhinolaryngologic Surgical Procedures/economics , Pharynx/surgery , Anesthesia, General/economics , Anesthesia, Local/economics , Humans , Netherlands , Otorhinolaryngologic Surgical Procedures/methods , United States
13.
Minerva Urol Nefrol ; 71(6): 636-643, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31287257

ABSTRACT

BACKGROUND: To investigate the applicability of the combined spinal-epidural anesthesia (CSEA) method in RIRS for the treatment of kidney stone disease and also to compare with general anesthesia (GA) in terms of their effects on early postoperative pain levels and their cost. METHODS: A hundred consecutive patients who were scheduled for RIRS were enrolled in this study and were prospectively evaluated according to the anesthesia methods. Patients were divided into 2 groups randomly: the GA (N.=50) and CSEA (N.=50) groups. Five patients were excluded due to patient incompatibility or inadequate anesthesia. The pain levels of patients in the Group 2 were recorded during the operation using the Visual Analog Scale (VAS) at minutes 1, 5, 10, 15, 30 and 60. Peak pain levels within the first 24 hours following the operation were recorded for both groups. RESULTS: Ninety five patients in the two groups were determined to be similar in terms of demographic characteristics. The mean VAS score at the postoperative 1st day was found as 1.20±0.9 for Group 1 and 0.82±1.3 for Group 2. No statistically significant differences were identified between the VAS-nram and VAS-ram groups (P=0.450). The total cost of anesthesia medications was similar between the both groups. CONCLUSIONS: Combined spinal-epidural anesthesia, which produces favorable outcomes in the intraoperative and postoperative periods, will become an alternative to general anesthesia. Also, the costs associated with these two anesthesia methods were calculated, it was found that the total cost of anesthesia medications and materials per operation was similar both methods.


Subject(s)
Anesthesia, Epidural/methods , Anesthesia, General/methods , Anesthesia, Spinal/methods , Kidney/surgery , Adult , Aged , Anesthesia, Epidural/economics , Anesthesia, General/economics , Anesthesia, Spinal/economics , Female , Humans , Intraoperative Period , Male , Middle Aged , Pain Measurement , Pain, Postoperative/epidemiology , Postoperative Complications/epidemiology , Prospective Studies , Treatment Outcome
14.
Am J Cardiol ; 124(1): 70-77, 2019 07 01.
Article in English | MEDLINE | ID: mdl-31064667

ABSTRACT

Conscious sedation (CS) has been increasingly utilized in transcatheter aortic valve implantation (TAVI). We aim to compare safety, efficacy, efficiency, and direct cost outcomes of patients who underwent TAVI with general anesthesia (GA) to those with CS. Records for all adult patients undergoing transfemoral TAVI at our institution between February 2012 and September 2018 were retrospectively screened. Patients were grouped by anesthesia treatment (GA or CS) and propensity matched. Safety (in-hospital and 30-day mortality, in-hospital and 30-day stroke, cardiac arrest, need for permanent pacemaker, and composite bleed/vascular adverse events), efficacy (follow-up echocardiographic findings), efficiency (procedure duration, fluoroscopy time, radiation dose, intensive care unit (ICU) stay, hospital length-of-stay, and discharge to home), and direct cost outcomes were compared. A total of 589 patients met our inclusion criteria. Propensity matching yielded 154 GA patients and 154 CS patients. There were no differences in the safety outcomes of in-hospital or 30-day mortality, in-hospital or 30-day stroke, cardiac arrest, and need for permanent pacemaker between GA and CS groups. There was a significant reduction in composite bleeding/vascular events in the CS group (8.4% vs 19.5%, p < 0.01). There were no differences in the follow-up echocardiograms with respect to aortic valve area, left ventricular ejection fraction, and incidence of moderate or severe aortic regurgitation. The CS group had shorter procedural fluoroscopy times and radiation dose, shorter length-of-stay and ICU stay, with similar procedural duration. CS patients were more likely to be discharged to home (59.7% vs 74.7%, p < 0.01). Total direct costs for CS were decreased in almost every departmental category, with a mean 10.4% reduction in overall direct costs (p < 0.001). In conclusion, TAVI with CS is associated with less bleeding and vascular events, lower procedural radiation exposure, reduced length of hospitalization and ICU stay, and lower direct costs in comparison with TAVI with GA. These outcomes occur without sacrificing procedural efficacy or safety.


Subject(s)
Anesthesia, General/adverse effects , Aortic Valve Stenosis/surgery , Conscious Sedation/adverse effects , Health Care Costs , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/economics , Aged , Aged, 80 and over , Anesthesia, General/economics , Aortic Valve Stenosis/economics , Aortic Valve Stenosis/mortality , Conscious Sedation/economics , Female , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Propensity Score , Retrospective Studies , Survival Rate , Treatment Outcome
15.
Turk Neurosurg ; 29(6): 843-850, 2019.
Article in English | MEDLINE | ID: mdl-30984998

ABSTRACT

AIM: To compare the effects of spinal anesthesia (SA) and general anesthesia (GA) in lumbar microdiscectomy in terms of their costeffectiveness, and perioperative outcomes. MATERIAL AND METHODS: We randomly allocated 100 consecutive patients who were scheduled to undergo elective lumbar microdiscectomy, into either SA or GA groups. We recorded and evaluated various parameters, including demographic aspects, body mass index (BMI), perioperative hemodynamics, time elapsed from operating room (OR) entry until incision, operative time, time elapsed from application of the surgical dressing to exiting OR, blood loss, post anesthetic care unit (PACU) time, preoperative and postoperative pain scores, postoperative analgesic requirements, first mobilization time, first oral intake, the length of hospital stay, time to return to work, and perioperative anesthetic costs. The patients, anesthesiologists, and neurosurgeons were handed a questionnaire before discharge to determine their satisfaction with the procedure. RESULTS: Several variables were found to be better in the SA group: the mean arterial pressure and heart rate changes were significantly lower, and the time elapsed from OR entry until incision, operative time, time elapsed from application of the surgical dressing to exiting OR, PACU time, the length of hospital stay, and time to return to work were shorter; furthermore, the postoperative pain scores, the analgesic requirements, the intraoperative blood loss, and the cost of anesthesia were all lower. Moreover the first mobilization and oral intake occurred earlier; and most significantly, the satisfaction of the patients and surgeons was higher in the SA group. Furthermore, we encountered no complications. CONCLUSION: Based on our results, we conclude that SA is reliable and clinically successful procedure in lumbar microdiscectomy.


Subject(s)
Anesthesia, General/economics , Anesthesia, Spinal/economics , Cost-Benefit Analysis/methods , Diskectomy/economics , Microsurgery/economics , Pain, Postoperative/economics , Adult , Anesthesia, General/methods , Anesthesia, Spinal/methods , Diskectomy/methods , Female , Humans , Length of Stay/trends , Lumbar Vertebrae/surgery , Male , Microsurgery/methods , Middle Aged , Pain, Postoperative/prevention & control , Treatment Outcome
16.
JACC Cardiovasc Interv ; 12(9): 835-843, 2019 05 13.
Article in English | MEDLINE | ID: mdl-30981573

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the association between the method of procedural sedation and outcomes for congenital cardiac catheterization procedures. BACKGROUND: The safety of operator-directed sedation (ODS) in the pediatric/congenital cardiac catheterization laboratory has been questioned. To our knowledge, the relative safety of ODS versus general anesthesia (GA) in these cases has not to date been critically evaluated. METHODS: A single-center retrospective cohort study was performed to compare the relative safety, cost, and times of catheterization procedures performed with ODS and those performed with GA from a cardiac anesthesiologist. The risk of adverse outcomes was compared using propensity-score-adjusted models. Using the same propensity score, procedure times and relative charges were also compared. RESULTS: Over the study period, 4,424 procedures in 2,547 patients were studied. Of these, 27% of cases were performed with ODS. ODS procedures were 70% diagnostic procedures, 17% device closure of patent ductus arteriosus, 5% balloon pulmonary valvuloplasty, and 3% pulmonary artery angioplasty. The risk of adverse event in adjusted models for ODS cases was significantly lower than in GA cases (odds ratio: 0.66; 95% confidence interval: 0.45 to 0.95; p = 0.03). Total room time and case time were also significantly shorter (p < 0.001). Professional (charge ratio: 0.88; p < 0.001) and hospital (charge ratio: 0.84; p < 0.001) charges for ODS cases were also lower than those for GA cases. CONCLUSIONS: This study demonstrates that clinical judgment can identify subjects in whom ODS is not associated with increased risk of adverse events. The use of ODS was associated with reduced case times and charges. In combination, these findings suggest that the selective use of ODS can allow for greater efficiency and higher value care without sacrificing safety.


Subject(s)
Anesthesia, General , Anesthesia, Local , Cardiac Catheterization , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/therapy , Hypnotics and Sedatives/administration & dosage , Operating Rooms , Adolescent , Adult , Anesthesia, General/adverse effects , Anesthesia, General/economics , Anesthesia, Local/adverse effects , Anesthesia, Local/economics , Cardiac Catheterization/adverse effects , Cardiac Catheterization/economics , Child , Child, Preschool , Clinical Decision-Making , Cost Savings , Cost-Benefit Analysis , Databases, Factual , Drug Costs , Female , Heart Defects, Congenital/economics , Hospital Costs , Humans , Hypnotics and Sedatives/adverse effects , Hypnotics and Sedatives/economics , Infant , Infant, Newborn , Male , Operating Rooms/economics , Patient Safety , Patient Selection , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Young Adult
17.
BMC Womens Health ; 19(1): 46, 2019 03 22.
Article in English | MEDLINE | ID: mdl-30902087

ABSTRACT

BACKGROUND: In women with abnormal uterine bleeding, fibroids are a frequent finding. In case of heavy menstrual bleeding and presence of submucosal type 0-1 fibroids, hysteroscopic resection is the treatment of first choice, as removal of these fibroids is highly effective. Hysteroscopic myomectomy is currently usually performed in the operating theatre. A considerable reduction in costs and a higher patient satisfaction are expected when procedural sedation and analgesia with propofol (PSA) in an outpatient setting is applied. However, both safety and effectiveness - including the necessity for re-intervention due to incomplete resection - have not yet been evaluated. METHODS: This study is a multicentre randomised controlled trial with a non-inferiority design and will be performed in the Netherlands. Women > 18 years with a maximum of 3 symptomatic type 0 or 1 submucosal fibroids with a maximum diameter of 3.5 cm are eligible to participate in the trial. After informed consent, 205 women will be randomised to either hysteroscopic myomectomy using procedural sedation and analgesia with propofol in an outpatient setting or hysteroscopic myomectomy using general anaesthesia in a clinical setting in the operating theatre. Primary outcome will be the percentage of complete resections, based on transvaginal ultrasonography 6 weeks postoperatively. Secondary outcomes are cost effectiveness, menstrual blood loss (Pictorial blood assessment chart), quality of life, pain, return to daily activities/work, hospitalization, (post) operative complications and re-interventions. Women will be followed up to one year after hysteroscopic myomectomy. DISCUSSION: This study may demonstrate comparable effectiveness of hysteroscopic myomectomy under procedural sedation and analgesia versus general anaesthesia in a safe and patient friendly environment, whilst achieving a significant cost reduction. TRIAL REGISTRATION: Dutch trial register, number NTR5357 . Registered 11th of August 2015.


Subject(s)
Analgesia/economics , Anesthesia, General/economics , Uterine Myomectomy/economics , Uterine Neoplasms/economics , Uterine Neoplasms/surgery , Adult , Analgesia/methods , Anesthesia, General/methods , Cost-Benefit Analysis , Female , Humans , Hysteroscopy/economics , Laparotomy/economics , Middle Aged , Netherlands , Pain Management , Patient Satisfaction , Uterine Myomectomy/methods
18.
Trials ; 20(1): 149, 2019 Feb 27.
Article in English | MEDLINE | ID: mdl-30813955

ABSTRACT

BACKGROUND: Although general anaesthesia (GA) with one-lung ventilation is the current standard of care, minor thoracoscopic surgery, i.e. treatment of pleural effusions, biopsies and small peripheral pulmonary wedge resections, can also be performed using local anaesthesia (LA), analgosedation and spontaneous breathing. Whilst the feasibility and safety of LA have been demonstrated, its impact on patient satisfaction remains unclear. Most studies evaluating patient satisfaction lack control groups or do not meet psychometric criteria. We report the design of the PASSAT trial (PAtientS' SATisfaction in thoracic surgery - general vs. local anaesthesia), a randomised controlled trial with a non-randomised side arm. METHODS: Patients presenting for minor thoracoscopic surgery and physical eligibility for GA and LA are randomised to surgery under GA (control group) or LA (intervention group). Those who refuse to be randomised are asked to attend the study on the basis of their own choice of anaesthesia (preference arm) and will be analysed separately. The primary endpoint is patient satisfaction according to a psychometrically validated questionnaire; secondary endpoints are complication rates, capnometry, actual costs and cost effectiveness. The study ends after inclusion of 54 patients in each of the two randomised study groups. DISCUSSION: The PASSAT study is the first randomised controlled trial to systematically assess patients' satisfaction depending on LA or GA. The study follows an interdisciplinary approach, and its results may also be applicable to other surgical disciplines. It is also the first cost study based on randomised samples. Comparison of the randomised and the non-randomised groups may contribute to satisfaction research. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00013661 . Registered on 23 March 2018.


Subject(s)
Anesthesia, General , Anesthesia, Local , Patient Satisfaction , Thoracic Surgery, Video-Assisted , Anesthesia, General/adverse effects , Anesthesia, General/economics , Anesthesia, Local/adverse effects , Anesthesia, Local/economics , Cost-Benefit Analysis , Hospital Costs , Humans , Psychometrics , Randomized Controlled Trials as Topic , Surveys and Questionnaires , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/economics , Treatment Outcome
19.
Arthroscopy ; 35(5): 1576-1581, 2019 05.
Article in English | MEDLINE | ID: mdl-30926191

ABSTRACT

PURPOSE: To analyze the individual costs associated with anterior crucial ligament reconstruction (ACLR), accounting for patient demographics, perioperative decision making, and location of the surgical procedure (hospital vs ambulatory surgery center), utilizing a cost-minimization analysis in a large national database. METHODS: Univariate analysis and multiple linear regression were performed to determine which patient and surgical variables were the largest cost drivers for ACLR in the United States according to the State Ambulatory Surgery and Services Database. RESULTS: The average cost for ACLR (n = 14,713) was $24,707 (standard deviation, $15,644). When patient variables were considered, younger age (P < .001), male sex (P < .001), Hispanic ethnicity (P < .001), number of chronic medical conditions (P < .001), Medicare insurance (P < .001), and quartile of household income (P < .001) were all associated with higher costs after ACLR. For operative variables, time spent in the operating room (P < .001), meniscal repair (P < .001), and use of general anesthesia alone (P < .001) were all associated with higher costs for ACLR. There was no significant difference between cost of surgery performed at a private surgery center and cost at a hospital-owned center. In the multivariate regression, the 3 variables with the greatest influence on cost of ACLR were use of isolated general anesthesia (associated with an increase of $2,049), Hispanic ethnicity ($1,828), and >1 chronic medical condition ($1,749). Male sex, time in operating room, and older age also significantly increased ACLR cost. CONCLUSIONS: The greatest contributor to cost of ACLR was the use of general anesthesia alone. Time spent in the operating room increased ACLR cost by $108 per minute. Patient factors included greater age, male sex, Hispanic ethnicity, number of chronic medical conditions, Medicare insurance, and annual income. Meniscal repair and regional nerve block did not significantly affect cost as determined by multivariate regression.


Subject(s)
Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction/economics , Health Care Costs/statistics & numerical data , Adolescent , Adult , Aged , Ambulatory Surgical Procedures/economics , Anesthesia, General/economics , Anterior Cruciate Ligament Injuries/economics , Anterior Cruciate Ligament Reconstruction/methods , Costs and Cost Analysis/methods , Female , Health Services Research/methods , Humans , Intraoperative Period , Male , Medicare , Socioeconomic Factors , United States , Young Adult
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