Comparison between traditional and goal directed perfusion in cardiopulmonary by-pass. A differential cost analysis in US

Povero, Massimiliano; Pradelli, Lorenzo

doi:10.7175/fe.v16i3.1200

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…[11][12][13] Recently, goal-directed perfusion (GDP), which attempts to maintain adequacy of perfusion through pump flow adjustments, demonstrated a lower occurrence of postoperative AKI, 15 shorter length of hospital stay, 15 and lower costs. 16 Many of those GDP studies defined the thresholds of nadir DO 2 levels by measuring the DO 2 levels every 10 to 20 minutes. However, DO 2 level is always dynamically changing, increasing the possibility that DO 2 levels might not reflect a critical condition between the sampling points.…”

Section: Perspectivementioning

confidence: 99%

Time–dose response of oxygen delivery during cardiopulmonary bypass predicts acute kidney injury

Mukaida

Matsushita

Kuwaki

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Previous studies have reported that nadir oxygen delivery during cardiopulmonary bypass is associated with the occurrence of postoperative acute kidney injury (AKI). However, these measurements only considered the bottom point of the oxygen delivery (DO 2 ) but did not consider the duration of DO 2 . We aimed to examine whether the time-dose response of DO 2 during cardiopulmonary bypass can be used to estimate the risk for postoperative AKI.Methods: We evaluated 112 patients who underwent cardiac surgeries with cardiopulmonary bypass. We analyzed the perfusion parameters recorded every 20 seconds. To obtain time-dose response of DO 2 index (DO 2 i), the area under the curve was calculated as below the 300 mL/min/m 2 threshold, which accounts for depth and duration of cumulative oxygen debt. In addition, the cumulative time below DO 2 i 300 mL/min/m 2 was also calculated. Receiver operating characteristic analysis, univariate regression analysis, and multivariate regression analysis were used to evaluate associations between perioperative variables and postoperative AKI.Results: Patients who developed AKI had larger area under the curve below the 300 mL/min/m 2 threshold (1581 vs 632; P<.01) and cumulative time below DO 2 i 300 mL/min/m 2 (34.7 vs 15.3 minutes; P<.01). Nadir DO 2 i was not significantly different between the non-AKI and AKI groups (263.4 vs 247.0 mL/min/m 2 ; P ¼ .291). Conclusions:The time-dose response of DO 2 i during cardiopulmonary bypass is a better indicator than nadir DO 2 i in evaluating AKI risk. Maintaining DO 2 i levels >300 mL/min/m 2 may result in decreased risk for postoperative AKI.

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Section: Perspectivementioning

confidence: 99%

Time–dose response of oxygen delivery during cardiopulmonary bypass predicts acute kidney injury

Mukaida

Matsushita

Kuwaki

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…Notably, fluctuations in nadir HCT during CPB and other GDP-related costs had no effect on overall spending because hospital charges were reduced. 39) This study has a number of limitations. First, there is a chance that data selection bias exists because of the small amount of research used in the study.…”

Section: Key Differencesmentioning

confidence: 94%

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index

Pratomo,

Sudadi,

Setianto

et al. 2024

ATCS

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CPB = cardiopulmonary bypass DO2 = oxygen delivery VO2 = oxygen consumption ICU = intensive care unit AKI = acute kidney injury GDP = goal-directed perfusion CI = cardiac index MAP = mean arterial pressure RCTs = randomized controlled trials PROSPERO = the international prospective register of systematic reviews PRISMA = preferred reporting items for the systematic reviews and meta-analyses PIC = population, intervention, control DO2I = oxygen delivery index LOS = length of stay Purpose: Goal-directed perfusion (GDP) refers to individualized goal-directed therapy using comprehensive monitoring and optimizing the delivery of oxygen during cardiopulmonary bypass (CPB). This study aims to determine whether the intraoperative GDP protocol method has better outcomes compared to conventional methods. Methods: We searched the PubMed, Central, and Scopus databases up to October 12, 2023. We primarily examined the GDP protocol in adult cardiac surgery, using CPB with oxygen delivery index (DO2I) and cardiac index (CI) as the main parameters. Results: In all, 1128 participants from seven studies were included in our analysis. The results showed significant differences in the duration of intensive care unit (ICU) stays (p = 0.01), with a mean difference of −0.33 (−0.59 to 0.07), and hospital length of stay (LOS) (p = 0.0002), with a mean difference of −0.84 (−1.29 to −0.39). There was also a notable reduction in postoperative complications (p <0.00001), odds ratio (OR) of 0.43 (0.32-0.60). However, there was no significant decrease in mortality rate (p = 0.54), OR of 0.77 (0.34-1.77). Conclusion: Postoperative acute kidney injury and ICU and hospital LOS are significantly reduced when GDP protocols with indicators of flow management, oxygen delivery index, and CI are used in intraoperative cardiac surgery using CPB.

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“…Costs considered in the analysis are direct health care costs, encompassing both in-hospital and long-term costs ( Table 1 ), in order to adopt a comprehensive third-party payer cost perspective. The in-hospital costs related to hospitalization for an AVR include operating room (both personnel and materials, excluding cost for the devices), 7 , 9 , 13 , 37 – 39 preoperative/intraoperative/postoperative diagnostic exams, 13 , 40 – 44 device costs, 7 , 45 , 46 reoperation for reexploration or second valve implantation, 47 – 49 hospital stay with or without mechanical ventilation, 50 – 56 blood transfusion, 37 , 50 , 51 , 57 , 58 need for renal replacement therapy, 50 , 51 , 57 , 59 and adverse events, such as stroke 49 , 54 , 60 – 62 or PMI. 37 , 38 , 48 , 49 , 54 , 63 According to the lifetime horizon of the simulation, patients who developed chronic renal dysfunction receive dialysis until death.…”

Section: Methodsmentioning

confidence: 99%

Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk

Povero¹,

Miceli²,

Pradelli³

et al. 2018

CEOR

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BackgroundMeta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device).ObjectiveThe objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia.MethodsA patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted.ResultsDue to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US).ConclusionSU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.

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Comparison between traditional and goal directed perfusion in cardiopulmonary by-pass. A differential cost analysis in US

Cited by 7 publications

References 10 publications

Time–dose response of oxygen delivery during cardiopulmonary bypass predicts acute kidney injury

Time–dose response of oxygen delivery during cardiopulmonary bypass predicts acute kidney injury

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index

Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk

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