Reddy P, Feret B M, Kulicki L, Donahue S, Quercia R A
Department of Pharmacy Practice, University of Connecticut, Storrs, USA.
J Clin Pharm Ther. 2002 Apr;27(2):127-32. doi: 10.1046/j.1365-2710.2002.00401.x.
Opiates such as remifentanil have the potential to reduce time to extubation (TTE), shorten length of stay (LOS) and lower hospital costs, because of a short duration of action. However, the cost of remifentanil is approximately ten times higher than longer-acting opiates like fentanyl.
The objective of this analysis was to compare TTE, LOS and total hospital costs between patients who received remifentanil and fentanyl during off-pump bypass surgery.
The study was prospective and observational in design. Consecutive patients who underwent off-pump cardiac bypass surgery and received either remifentanil or fentanyl from September 1998 to August 1999 were screened for study entry. Patient bills and charges were converted to costs using hospital cost-to-charge ratios. The percent of patients' extubated in the operating room (OR), LOS and hospital costs were compared between the groups.
The baseline demographics (age: 66 +/- 12 years mean +/- SD; female 36%) and intraoperative variables were similar between the remifentanil (n=39) and fentanyl (n=20) groups. Patients given remifentanil during surgery were significantly more likely to be extubated in the OR than patients given fentanyl (15 vs. 64%; P < 0.001). Mean LOS was similar in both groups (7.3 +/- 3.1 vs. 8.3 +/- 2.7 days; P=0.27). Patients who received remifentanil incurred lower pulmonary function testing ($0 +/- 0 vs. $34 +/- 103; P=0.045), recovery room ($31 +/- 40 vs. $65 +/- 33; P=0.002) and lower ward costs ($3973 +/- 1719 vs. $4808 +/- 1794; P=0.09) than patients who received fentanyl. Anesthesia costs were higher among patients who received remifentanil ($476 +/- 102 vs. $416 +/- 130; P=0.06). Medical and surgical supplies, OR, intensive care unit, laboratory, respiratory therapy, pharmacy, radiology and transfusion costs were similar between the two groups. The total cost was $15 272 +/- 5556 and $15 616 +/- 4169 in the remifentanil and fentanyl groups, respectively (P=0.81).
Remifentanil, when used in off-pump bypass surgery, is associated with an increased likelihood of extubation in the OR. However, LOS and total hospital costs remain unchanged.
瑞芬太尼等阿片类药物由于作用持续时间短，有可能缩短拔管时间（TTE）、缩短住院时间（LOS）并降低医院成本。然而，瑞芬太尼的成本大约是芬太尼等长效阿片类药物的十倍。
本分析的目的是比较在非体外循环搭桥手术中接受瑞芬太尼和芬太尼的患者之间的拔管时间、住院时间和医院总费用。
该研究为前瞻性观察性设计。对1998年9月至1999年8月期间接受非体外循环心脏搭桥手术并接受瑞芬太尼或芬太尼的连续患者进行筛选以纳入研究。使用医院成本与收费比率将患者账单和收费转换为成本。比较两组在手术室（OR）拔管的患者百分比、住院时间和医院成本。
瑞芬太尼组（n = 39）和芬太尼组（n = 20）之间的基线人口统计学特征（年龄：66±12岁，平均±标准差；女性36%）和术中变量相似。手术期间接受瑞芬太尼的患者在手术室拔管的可能性明显高于接受芬太尼的患者（15%对64%；P < 0.001）。两组的平均住院时间相似（7.3±3.1天对8.3±2.7天；P = 0.27）。接受瑞芬太尼的患者的肺功能测试费用（0±0美元对34±103美元；P = 0.045）、恢复室费用（31±40美元对65±33美元；P = 0.002）和病房费用（3973±1719美元对4808±1794美元；P = 0.09）低于接受芬太尼的患者。接受瑞芬太尼的患者的麻醉费用较高（476±102美元对416±130美元；P = 0.06）。两组之间的医疗和手术用品、手术室、重症监护病房、实验室、呼吸治疗、药房、放射学和输血费用相似。瑞芬太尼组和芬太尼组的总成本分别为15272±5556美元和15616±4169美元（P = 0.81）。
在非体外循环搭桥手术中使用瑞芬太尼与在手术室拔管的可能性增加有关。然而，住院时间和医院总费用保持不变。
