Section of Cardiology, Department of Medicine, Washington Hospital Center, 110 Irving Street, NW, Room 1E12, Washington, DC 20010-2975, USA.
Int J Cardiovasc Imaging. 2013 Mar;29(3):709-17. doi: 10.1007/s10554-012-0133-2. Epub 2012 Oct 12.
While multi-detector cardiac computed tomography angiography (MDCCTA) prior to reoperative cardiac surgery (RCS) has been associated with improved clinical outcomes, its impact on hospital charges and length of stay remains unclear. We studied 364 patients undergoing RCS at Washington Hospital Center between 2004 and 2008, including 137 clinically referred for MDCCTA. Baseline demographics, procedural data, and perioperative outcomes were recorded at the time of the procedure. The primary clinical endpoint was the composite of perioperative death, myocardial infarction (MI), stroke, and hemorrhage-related reoperation. Secondary clinical endpoints included surgical procedural variables and the perioperative volume of bleeding and transfusion. Length of stay was determined using the hospital's electronic medical record. Cost data were extracted from the hospital's billing summary. Analysis was performed on individual categories of care, as well as on total hospital charges. Data were compared between subjects with and without MDCCTA, after adjustment for the Society of Thoracic Surgeons score. Baseline characteristics were similar between the two groups. MDCCTA was associated with shorter procedural times, shorter intensive care unit stays, fewer blood transfusions, and less frequent perioperative MI. There was additionally a trend towards a lower incidence of the primary endpoint (17.5 vs. 24.2 %, p = 0.13) primarily due to a lower incidence of perioperative MI (0 vs. 5.7 %, p = 0.002). MDCCTA was also associated with lower median recovery room [$1,325 (1,250-3,302) vs. $3,217 (1,325-5,353) p < 0.001] and nursing charges [$6,335 (3,623-10,478) vs. $6,916 (3,915-14,499) p = 0.03], although operating room charges were higher [$24,100 (22,300-29,700) vs. $23,500 (19,900-27,700) p < 0.05]. Median total charges [$127,000 (95,000-188,000) vs. $123,000 (86,800-226,000) p = 0.77] and length of stay [9 days (6-19) vs. 11 days (7-19), p = 0.21] were similar. Means analysis demonstrated a strong trend towards lower mean total hospital charges [$163,000 (108,426) vs. $192,000 (181,706), p = 0.06] in the MDCCTA group. In conclusion, preoperative MDCCTA is associated with a number of improved perioperative outcomes and does not significantly effect the length of stay or total hospital charges during the index hospitalization.
虽然多排螺旋 CT 血管造影术（MDCCTA）在再次心脏手术（RCS）前与改善临床结果相关，但它对医院费用和住院时间的影响尚不清楚。我们研究了 2004 年至 2008 年期间在华盛顿医院中心接受 RCS 的 364 例患者，其中 137 例因临床需要进行 MDCCTA。记录了手术时的基线人口统计学资料、手术数据和围手术期结果。主要临床终点是围手术期死亡、心肌梗死（MI）、卒中和与出血相关的再次手术的复合终点。次要临床终点包括手术程序变量以及围手术期出血和输血量。使用医院的电子病历确定住院时间。从医院的计费摘要中提取费用数据。对个别护理类别以及总医院费用进行了分析。在调整胸外科医师协会评分后，对有和没有 MDCCTA 的患者进行了比较。两组的基线特征相似。MDCCTA 与较短的手术时间、较短的重症监护病房停留时间、较少的输血和较少的围手术期 MI 相关。主要终点的发生率也呈下降趋势（17.5% vs. 24.2%，p=0.13），主要是由于围手术期 MI 的发生率较低（0% vs. 5.7%，p=0.002）。MDCCTA 还与较低的恢复室中位数费用[1325 美元（1250-3302 美元）vs. 3217 美元（1325-5353 美元），p<0.001]和护理费用[6335 美元（3623-10478 美元）vs. 6916 美元（3915-14499 美元），p=0.03]相关，尽管手术室费用较高[24100 美元（22300-29700 美元）vs. 23500 美元（19900-27700 美元），p<0.05]。中位数总费用[127000 美元（95000-188000 美元）vs. 123000 美元（86800-226000 美元），p=0.77]和住院时间[9 天（6-19）vs. 11 天（7-19），p=0.21]相似。均值分析显示，MDCCTA 组的总医院费用均值有明显下降的趋势[163000 美元（108426 美元）vs. 192000 美元（181706 美元），p=0.06]。总之，术前 MDCCTA 与许多围手术期结果的改善相关，并且在指数住院期间不会显著影响住院时间或总医院费用。
