Ammar A D
Department of Surgery, University of Kansas School of Medicine, Wichita, USA.
J Vasc Surg. 1996 Dec;24(6):1050-6. doi: 10.1016/s0741-5214(96)70052-6.
This study was performed to determine whether comprehensive cost-cutting strategies adversely affect the outcome in patients undergoing carotid endarterectomy.
From December 1994 to December 1995, 237 consecutive patients undergoing 260 carotid endarterectomies were prospectively studied. The following variables were assessed: carotid arteriography, preoperative laboratory tests, electrocardiograms and chest x-ray films, use of carotid shunts during operation, use of pathology department, intensive care, oxygen therapy, telemetry, and hospital stay. In addition, complications were tabulated.
Previously, all variables evaluated were routinely ordered. Subsequent to initiating the cost-containment strategies, the following results were achieved: arteriography in 52 (22%) of 237 patients, preoperative complete blood cell count and SMA-7 in 161 (62%) of 260 cases, preoperative electrocardiograms in 185 (71%) of 260 cases, preoperative chest x-ray films in 190 (73%) of 260 cases, carotid shunts in 83 (32%) of 260 cases, disease in no cases (0%), intensive care in 29 (11%) of 260 cases, oxygen therapy in 34 (13%) of 260 cases, telemetry in 17 (7%) of 260 cases, and hospital stay was decreased from an average of 2.6 to 1.3 days. Total savings based on average hospital and physician charges was $2.3 million. Complications included four strokes, one myocardial infarction, and no deaths. No patient required readmission. No recurrent or new neurologic or cardiac findings were identified clinically in follow-up at 1 and 4 weeks after surgery.
The results clearly demonstrate that comprehensive cost-cutting strategies can reduce charges significantly while maintaining patient safety.
本研究旨在确定全面的成本削减策略是否会对接受颈动脉内膜切除术的患者的治疗结果产生不利影响。
对1994年12月至1995年12月期间连续接受260例颈动脉内膜切除术的237例患者进行前瞻性研究。评估了以下变量：颈动脉血管造影、术前实验室检查、心电图和胸部X光片、手术期间颈动脉分流管的使用、病理科的使用、重症监护、氧疗、遥测以及住院时间。此外，还列出了并发症情况。
此前，所有评估变量均按常规进行检查。在启动成本控制策略后，取得了以下结果：237例患者中有52例（22%）进行了血管造影，260例病例中有161例（62%）进行了术前全血细胞计数和血清酶谱分析，260例病例中有185例（71%）进行了术前心电图检查，260例病例中有190例（73%）进行了术前胸部X光片检查，260例病例中有83例（32%）使用了颈动脉分流管，无病例（0%）进行病理检查，260例病例中有29例（11%）接受了重症监护，260例病例中有34例（13%）接受了氧疗，260例病例中有17例（7%）进行了遥测，住院时间从平均2.6天降至1.3天。基于平均住院和医生收费计算，总共节省了230万美元。并发症包括4例中风、1例心肌梗死，无死亡病例。无患者需要再次入院。术后1周和4周的随访中，临床上未发现复发性或新的神经或心脏问题。
结果清楚地表明，全面的成本削减策略可以在保持患者安全的同时显著降低费用。
