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Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
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Is resternotomy in cardiac surgery still a problem?

David Morales1, Erin Williams, Ranjit John

  • 1Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, MC-WT 19345H, Houston, TX 77030, USA. dlmorale@texaschildrenshospital.org

Interactive Cardiovascular and Thoracic Surgery
|June 8, 2010
PubMed
Summary

Resternotomy (RS) for heart reoperations presents significant, underestimated complications and costs. Further research is needed to evaluate cost-effectiveness of safety strategies for these complex cardiac surgeries.

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Area of Science:

  • Cardiovascular Surgery
  • Health Economics
  • Medical Technology Assessment

Background:

  • Reoperations for cardiovascular diseases are increasing in the US.
  • The economic impact and complication rates of resternotomy (RS) are not well-defined.
  • Surgeon surveys suggest higher complication rates than previously reported.

Purpose of the Study:

  • To review the literature on morbidity and resource utilization in cardiac reoperation via resternotomy (RS).
  • To identify key issues for future studies on the cost-effectiveness of RS safety strategies.
  • To clarify the health economic burden of resternotomy (RS).

Main Methods:

  • Literature review of published studies on cardiac reoperation and resternotomy (RS).
  • Analysis of morbidity and resource utilization data associated with RS.
  • Identification of safety strategies and their unexplored cost-effectiveness.

Main Results:

  • Published data often underreport catastrophic hemorrhage and mortality during RS.
  • Practicing surgeons report higher complication frequencies.
  • The cost-effectiveness of various RS safety strategies remains largely unexplored.

Conclusions:

  • Accurate quantification of the health economic burden of resternotomy (RS) is challenging but crucial.
  • Differentiating the value of RS safety strategies requires assessing clinical benefits, costs, and resource impact.
  • Future studies must address the economic and clinical value of interventions in cardiac reoperation.