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Reduction in costs, blood products, and operating time in patients undergoing open heart surgery
R R Lazzara1, F E Kidwell, M F Kraemer
1Division of Cardiac Surgery, St Charles Medical Center, Bend, Ore, USA.
Insights
Using aprotinin at half dose during open heart surgery significantly reduced costs and blood product use. This approach proved more cost-effective than full-dose aprotinin or no aprotinin, while maintaining efficacy.
Area of Science:
- Cardiovascular Surgery
- Pharmacoeconomics
- Anesthesiology
Background:
- Aprotinin is used to reduce blood loss during open heart surgery.
- The cost-effectiveness of different aprotinin dosages requires evaluation.
Purpose of the Study:
- To compare the cost-effectiveness and efficacy of half-dose aprotinin versus full-dose or no aprotinin during open heart surgery.
Main Methods:
- Prospective, unmasked comparison of 133 patients undergoing open heart surgery.
- Patients received no aprotinin, full-dose aprotinin, or half-dose aprotinin.
- Outcomes measured included total costs, blood product administration, and operating room closure time.
Main Results:
- Both full-dose and half-dose aprotinin significantly reduced blood product use and operating room closure time (P < .05).
- Half-dose aprotinin yielded significant cost savings compared to no aprotinin and full-dose aprotinin (P < .05).
Conclusions:
- Half-dose aprotinin is a cost-effective strategy for open heart surgery.
- It reduces costs, blood product requirements, and operating room time in community hospitals.
Objective:
To test the hypothesis that use of aprotinin at hall dose would be more cost-effective or as efficacious as full-dose aprotinin or no aprotinin during open heart surgery.
Design:
Cost-effective analysis, unmasked prospective comparison.
Setting:
Community hospital.
Patients:
One hundred thirty-three patients undergoing open heart surgery.
Interventions:
Patients in 3 consecutive groups undergoing open heart surgery were allocated to receive no aprotinin, full-dose aprotinin, or half-dose aprotinin.
Main Outcome Measures:
Total cost (in dollars) of blood products administered plus cost of aprotinin at various dosages, comparison of total blood products administered during hospitalization, and closure time required in the operating room.
Results:
Full-dose and half-dose aprotinin significantly (P < .05) reduced the total blood products administered during hospitalization and the operating room closure time. However, use of half-dose aprotinin resulted in a significant cost savings (P < .05) when compared with either the cost of blood products required in the nodose aprotinin group or the cost of blood products plus aprotinin in the full-dose aprotinin group.
Conclusion:
Use of aprotinin at half dose in a community hospital resulted in a significant reduction in costs, blood product use, and operating room closure time in patients undergoing open heart surgery.