Division of Pediatric Cardiac Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn; Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn.
Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn.
J Thorac Cardiovasc Surg. 2020 Dec;160(6):1559-1566. doi: 10.1016/j.jtcvs.2020.04.037. Epub 2020 May 4.
Infants undergoing congenital heart surgery require central venous lines which can be achieved by various combinations of transthoracic lines, percutaneous-indwelling central catheters and tunneled Broviac catheters. Transthoracic lines are removed by protocol prior to cardiac intensive care unit discharge (risk of bleeding), at which time percutaneous-indwelling central catheters are placed. Transdiaphragmatic tunneled Broviac catheters placed at the time of sternotomy, remain in place until hospital discharge, when they are safely removed at bedside. We characterized actual cost profiles associated with strategies that do versus do not include tunneled Broviac catheters.
From January 2014 to December 2016, we identified a study population of 220 consecutive patients under 1 year of age undergoing congenital heart surgery. Cost data were acquired from our electronic patient system interface database and office of finance. Our cohort was divided into 2 groups, tunneled Broviac catheter and nontunneled Broviac catheter. We calculated the total cost associated with each groups' central venous lines, propensity matched, and used the Mann-Whitney U test to analyze the results.
Eighty-three (37.7%) of the 220 patients had tunneled Broviac catheters. The tunneled Broviac catheter group had 4 percutaneous-indwelling central catheter insertions and 6 radiological interventions while the nontunneled Broviac catheter group had 90 percutaneous-indwelling central catheters and 203 radiologic interventions. After propensity score matching, both groups were reduced to 82 patients and sum, median and interquartile range cost for tunneled Broviac catheters and nontunneled Broviac catheters was $17,351.84, $159.76 (128-159.76) versus $72,809.32, $1277.26 (31.76-1277.26), P < .02 respectively.
Tunneled Broviac catheters, placed routinely at cardiac surgery, incur lower costs than the conventional combination of transthoracic lines and percutaneous-indwelling central catheters. The cost-effectiveness is achieved by reducing the number of percutaneous-indwelling central catheters and associated radiologic interventions.
接受先天性心脏手术的婴儿需要中心静脉置管，这可以通过经胸置管、经皮留置中央导管和隧道式 Broviac 导管的各种组合来实现。在心脏重症监护病房出院前（有出血风险），按方案移除经胸置管，此时放置经皮留置中央导管。在胸骨切开术时放置的经膈肌隧道式 Broviac 导管，一直保留到出院时，然后在床边安全地移除。我们描述了与包括和不包括隧道式 Broviac 导管的策略相关的实际成本概况。
从 2014 年 1 月至 2016 年 12 月，我们确定了 220 名接受先天性心脏手术的年龄在 1 岁以下的连续患者的研究人群。成本数据来自我们的电子患者系统接口数据库和财务办公室。我们的队列分为两组，即隧道式 Broviac 导管组和非隧道式 Broviac 导管组。我们计算了每组中心静脉置管的总费用，进行了倾向匹配，并使用曼-惠特尼 U 检验进行了分析。
220 名患者中有 83 名（37.7%）有隧道式 Broviac 导管。隧道式 Broviac 导管组有 4 次经皮留置中央导管插入和 6 次放射学干预，而非隧道式 Broviac 导管组有 90 次经皮留置中央导管和 203 次放射学干预。经过倾向评分匹配后，两组均减少到 82 名患者，隧道式 Broviac 导管和非隧道式 Broviac 导管的总、中位数和四分位间距成本分别为$17,351.84、$159.76（128-159.76）和$72,809.32、$1277.26（31.76-1277.26），P<.02。
在心脏手术中常规放置的隧道式 Broviac 导管比经胸置管和经皮留置中央导管的常规组合成本更低。这种成本效益是通过减少经皮留置中央导管的数量和相关的放射学干预来实现的。
