• R Svedjeholm, U Alström, L-Å Levin, E Ståhle, and O Friberg.
• Department of Cardiothoracic Surgery and Anaesthesia, Uppsala University Hospital, Uppsala, Sweden. u.a@surgsci.uu.se
• Br J Anaesth. 2012 Feb 1;108(2):216-22.

BackgroundRe-exploration for bleeding after cardiac surgery is an indicator of substantial haemorrhage and is associated with increased hospital resource utilization. This study aimed to analyse the costs of re-exploration and estimate the costs of haemostatic prophylaxis.MethodsA total of 4232 patients underwent isolated, first-time, coronary artery bypass graft (CABG) surgery during 2005-8. Each patient re-explored for bleeding (n=127) was matched with two controls not requiring re-exploration (n=254). Cost analysis was based on resource utilization from completion of CABG until discharge. A mean cost per patient for re-exploration was calculated. Based on this, the net cost of prophylactic treatment with haemostatic drugs for preventing re-exploration was calculated.ResultsPatients undergoing re-exploration had higher exposure to clopidogrel before operation, prolonged stays in the intensive care unit, and more blood transfusions than controls. The mean incremental cost for re-exploration was €6290 [95% confidence interval (CI) €3408-€9173] per patient, of which 48% [€3001 (95% CI €249-€2147)] was due to prolonged stay, 31% [€1928 (95% CI €1710-€2147)] to the cost of surgery/anaesthesia, 20% [€1261 (95% CI €1145-€1378)] to the increased number of blood transfusions, and <2% [€100 (95% CI €39-€161)] to the cost of haemostatic drugs. A cost model, at an estimated 50% efficacy for recombinant activated clotting factor VIIa and a 50% expected risk for re-exploration without prophylaxis, demonstrated that to be cost neutral, prophylaxis of four patients needed to result in one avoided re-exploration.ConclusionsThe resource utilization costs were substantially higher in patients requiring re-exploration for bleeding. From a strict cost-effectiveness perspective, clinical interventions to prevent haemorrhage might be underutilized.

41 keywords...

hide…