Cheng D C, Karski J, Peniston C, Raveendran G, Asokumar B, Carroll J, David T, Sandler A
Department of Anesthesia, Toronto Hospital, University of Toronto, Ontario, Canada.
Anesthesiology. 1996 Dec;85(6):1300-10. doi: 10.1097/00000542-199612000-00011.
Economics has caused the trend of early tracheal extubation after cardiac surgery, yet no prospective randomized study has directly validated that early tracheal extubation anesthetic management decreases costs when compared with late extubation after cardiac surgery.
This prospective, randomized, controlled clinical trial was designed to evaluate the cost savings of early (1-6 h) versus late tracheal extubation (12-22 h) in patients after coronary artery bypass graft (CABG) surgery. The total cost for the services provided for each patient was determined for both the early and late groups from hospital admission to discharge home. All costs applicable to each of the services were classified into direct variables, direct fixed costs, and overhead (an indirect cost). Physician fees and heart catheterization costs were included. The total service cost was the sum of unit workload and overhead costs.
One hundred patients having elective CABG who were younger than 75 yr were studied. Including all complications, early extubation (n = 50) significantly reduced cardiovascular intensive care unit (CVICU) costs by 53% (P < 0.026) and the total CABG surgery cost by 25% (P < 0.019) when compared with late extubation (n = 50). Forty-one patients (82%) in each group were tracheally extubated within the defined period. In the early extubation group, the actual departmental cost savings in CVICU nursing and supplies was 23% (P < 0.005), in ward nursing and supplies was 11% (P < 0.05), and in respiratory therapy was 12% (P < 0.05). The total cost savings per patient having CABG was 9% (P < 0.001). Further cost savings using discharge criteria were 51% for CVICU nursing and supplies (P < 0.001), 9% for ward nursing and supplies (P < 0.05), and 29% for respiratory therapy (P < 0.001), for a total cost savings per patient of 13% (P < 0.001). Early extubation also reduced elective case cancellations (P < 0.002) without any increase in the number of postoperative complications and readmissions.
Early tracheal extubation anesthetic management reduces total costs per CABG surgery by 25%, predominantly in nursing and in CVICU costs. Early extubation reduces CVICU and hospital length of stay but does not increase the rate or costs of complications when compared with patients in the late extubation group. It shifts the high CVICU costs to the lower ward costs. Early extubation also improves resource use after cardiac surgery when compared with late extubation.
经济学因素推动了心脏手术后早期气管拔管的趋势，但尚无前瞻性随机研究直接证实，与心脏手术后延迟拔管相比，早期气管拔管的麻醉管理可降低成本。
本前瞻性、随机、对照临床试验旨在评估冠状动脉旁路移植术（CABG）后患者早期（1 - 6小时）与延迟气管拔管（12 - 22小时）的成本节约情况。确定早期和晚期两组患者从入院到出院所提供服务的总成本。适用于每项服务的所有成本分为直接变量、直接固定成本和间接费用（间接成本）。包括医师费用和心脏导管插入术成本。总服务成本是单位工作量成本和间接费用的总和。
研究了100例年龄小于75岁的择期CABG患者。包括所有并发症，与延迟拔管组（n = 50）相比，早期拔管组（n = 50）显著降低了心血管重症监护病房（CVICU）成本53%（P < 0.026），CABG手术总成本降低25%（P < 0.019）。每组41例患者（82%）在规定时间内气管拔管。在早期拔管组，CVICU护理和用品的实际科室成本节约为23%（P < 0.005），病房护理和用品节约11%（P < 0.05），呼吸治疗节约12%（P < 0.05）。每位CABG患者的总成本节约为9%（P < 0.001）。使用出院标准进一步节约的成本为：CVICU护理和用品51%（P < 0.001），病房护理和用品9%（P < 0.05），呼吸治疗29%（P < 0.001），每位患者总成本节约13%（P < 0.001）。早期拔管还减少了择期手术取消率（P < 0.002），且术后并发症和再入院人数未增加。
早期气管拔管的麻醉管理使每例CABG手术的总成本降低25%，主要是护理和CVICU成本。与延迟拔管组患者相比，早期拔管缩短了CVICU和住院时间，但未增加并发症发生率或成本。它将高昂的CVICU成本转移到了较低的病房成本。与延迟拔管相比，早期拔管还改善了心脏手术后的资源利用情况。
