Background: Since the prospective payment system, health institutions have only specific payments for the emergency care in the emergency room. The direct urgent admissions in coronary care units for acute coronary syndrome (ACS) do not collect this complementary refund. For the patient's stay, hospital is remunerated with fixed national prices which are similar even in case of emergent or planed coronary revascularization when realized.
Aims: To analyze and compare the financial impact between emergent and planed coronary stenting in the setting of ACS.
Patients And Methods: This retrospective study was based on patients suffering from ACS who experienced emergent coronary stenting during the year 2005. On 154 patients, 127 were age-, sex- and diagnosis-related group (called "groupe homogène de malades" in the French Health Care system)-matched with 127 suffering from same ACS but with planed "ad hoc" coronary stenting. The overall charges (medical and paramedical team, pharmacy, biology, implantable coronary devices, radiology) were compared between the two groups.
Results: Mean stay duration was 6.7 days and did not differ between the two groups. Mean financial retributions were significantly higher in the emergent group (7338 euro [6831-7846] IC95 vs 6509 euro [5994-7023]; p=0,02) but with a much more raised consumption (6810 euro [6283-7336] vs 5223 euro [4632-5814]; p=0,001). This overcost was due especially to drugs and biological expenses. The hospitalization payments did not cover the overall expenses for 25% of the patients' stays (N=64) among whom 39 have had emergent coronary stenting (30.7%, p=0.04). Among the different GHM, the most important difference was observed in non-STEMI without complication with a negative receipts/costs ratio for 37.8% of the stay with coronary stenting in emergency.
Conclusion: The application of the recent guidelines for coronary revascularization in the management of ACS represents a financial venture for hospital institutions. The engaged charges for emergent coronary stenting are covered with difficulties contrary to planed revascularization.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.acvd.2009.02.017 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Pulmonary Atresia Intact Ventricular Septum With Anomalous Left Coronary Artery From Pulmonary Artery.
Ann Thorac Surg Short Rep
December 2024
Children's Heart Institute, Children's Memorial Hermann Hospital, Houston, Texas.
A patient with known pulmonary atresia and intact ventricular septum and ductal stent presented with low cardiac output and arrythmia. Intraoperatively, the patient was found to have an anomalous left coronary artery arising from the pulmonary artery. After reimplantation of the left coronary artery to the aortic root and placement of a central shunt, the patient progressed well and was discharged home.
View Article and Find Full Text PDFDiffuse Coronary Vasospasm After Zone 2 Debranching and Antegrade TEVAR.
Ann Thorac Surg Short Rep
December 2024
Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
Coronary vasospasm involves constriction of the coronary arteries and has been described after manipulation of the coronary arteries (ie, after stenting or bypass grafting). This report details the case of a 57-year-old man who presented with an endoleak after thoracic endovascular aortic repair. He underwent a frozen elephant trunk procedure and postoperatively had diffuse coronary vasospasm, demonstrated on pre- and post-vasospasm cardiac catheterization.
View Article and Find Full Text PDFArch Bare Metal Stent Grafting in Type I Aortic Dissections After Hemiarch Repair.
Ann Thorac Surg Short Rep
December 2024
Division of Cardiac Surgery, Inova Heart and Vascular Institute, Inova Health Systems, Falls Church, Virginia.
Background: DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.
View Article and Find Full Text PDFLEGMO: Extremity Salvage Using Extracorporeal Membrane Oxygenation.
Ann Thorac Surg Short Rep
March 2023
Department of Vascular Surgery, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Mycotic aneurysm management balances the urgency of excising infected vasculature with the need to revascularize in or near an infected field. We present a case of a 47-year-old man with sepsis, a failed kidney transplant, and a ruptured, previously stented right external iliac pseudoaneurysm. After excision of the infected pseudoaneurysm and stents, lower extremity revascularization was delayed through the innovative use of isolated limb perfusion using extracorporeal membrane oxygenation followed by staged extra-anatomic femoral-femoral bypass.
View Article and Find Full Text PDFCAS-OPCABG vs OPCABG-alone in patients with asymptomatic carotid Stenosis: Multi-center experience.
Int J Cardiol Heart Vasc
February 2025
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Objective: The objective was to evaluate the relationship between carotid stenting and off-pump coronary artery grafting (CAS-OPCABG) and OPCABG only in patients with asymptomatic severe carotid stenosis.
Methods: This study retrospectively included 669 patients with asymptomatic severe carotid artery stenosis who underwent OPCABG at multiple centers. After propensity score matching for baseline characteristics, the study compared two groups of patients with clinical data, early and midterm death, stroke, and myocardial infarction (MI).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!