Cost Of Procedure Research Articles

True cost estimation of common imaging procedures for cost-effectiveness analysis - insights from a Singapore hospital emergency department

ObjectivesThere is a lack of clear and consistent cost reporting for cost-effectiveness analysis in radiology. Estimates are often obtained using costing derived from hospital charge records. This study aims to evaluate the accuracy of hospital charge records compared to a Singapore hospital's true diagnostic imaging costs. MethodsA seven-step process involving a bottom-up micro-costing approach was devised and followed to calculate the cost of imaging using actual data from a clinical setting. We retrieved electronic data from a random sample of 96 emergency department patients who had CT brain, CT and X-ray cervical spine, and X-ray lumbar spine performed to calculate the parameters required for cost estimation. We adjusted imaging duration and number of performing personnel to account for variations. ResultsOur approach determined the average cost for the following imaging procedures: CT brain (€154.00), CT and X-ray cervical spine (€177.14 and €68.22), and X-ray lumbar spine (€79.85). We found that the true cost of both conventional radiography procedures was marginally higher than the subsidized patient charge, and all costs were slightly lower than the private patient charge except for X-ray lumbar spine (€73.49 vs.€79.85). We identified larger differences in cost for both CT procedures and smaller differences in cost for conventional radiography procedures, depending on the patient's private or subsidized status. For private status, the differences were: CT brain (Min: €194.20; Max: €264.40), CT cervical spine (Min: €219.54; Max: €399.05), X-ray cervical spine (Min: €5.27; Max: €61.94), and X-ray lumbar spine (Min: €6.36; Max: €108.04), while for subsidized status, the differences were: CT brain (Min: €7.56; Max: €62.64), CT cervical spine (Min: €47.02; Max: €132.49), X-ray cervical spine (Min: €15.88; Max: €103.44), and X-ray lumbar spine (Min: €13.66; Max: €149.44). Considering examination duration and the number of personnel engaged in a procedure, there were significant variations in the minimum, average, and maximum imaging costs. ConclusionThere is a modest gap between hospital charges and actual costs, and we must therefore exercise caution and recognize the limitations of utilizing hospital charge records as absolute metrics for cost-effectiveness analysis. Our detailed approach can potentially enable more accurate imaging cost determination for future studies.

Robotic carotid artery stenting: a multicenter, propensity score–matched analysis of clinical outcomes and cost-effectiveness

OBJECTIVE Preclinical studies suggest that robotic carotid artery stenting (CAS) could be superior to manual CAS. However, very limited comparative data exist for patients who have undergone robotic versus manual CAS. In addition, no data exist comparing the costs of manual and robotic CAS. METHODS All robotic CAS cases at two academic neurosurgery centers were retrospectively reviewed and 1:1 propensity matched with manual CAS cases. Personnel costs, supply costs, and total procedure costs were collected in collaboration with hospital administration by using time-driven activity-based cost analysis. RESULTS A total of 24 robotic CAS operations were performed between 2019 and 2023. Comorbidities and baseline procedural characteristics were well matched between robotic and manual cases. Unplanned manual conversion was observed in only 1 robotic case (4.2%). Robotic CAS complications and outcomes were comparable to manual. Robotic CAS was associated with a significantly increased fluoroscopy time (29.0 vs 19.2 minutes; p < 0.001). Robotic procedure time (88.9 ± 18.2 minutes) was significantly (p = 0.003) longer than manual time (68.72 ± 22.4 minutes). Health personnel costs ($1589.71 ± $176.92 vs $1375.99 ± $233.39, p = 0.005); supply costs ($3918.25 ± $421.20 vs $2152.74 ± $1030.26, p < 0.001); and total procedure costs ($5306.11 ± $608.95 vs $3437.56 ± $1165.67, p < 0.001) were greater for robotic CAS. CONCLUSIONS In the first multicenter study and largest sample to date, the authors show that robotic CAS, with a low rate of procedural failure and postoperative complications, is safe and feasible. In addition, robotic CAS achieves comparable clinical outcomes to manual CAS. Robotic CAS was associated with increased fluoroscopy time, but fluoroscopy time decreased as operators gained familiarity with the CorPath GRX system. Robotic CAS was associated with a greater procedural cost, which was driven by greater personnel and supply costs. Robotic CAS failed to show superiority to manual CAS. These findings set a foundation for randomized controlled trials of robotic CAS, and also highlight the need for further studies to optimize robotic CAS and reduce its associated costs.

Factors influencing white blood cell mobilisation in healthy granulocyte donors.

Granulocyte transfusions represent a therapeutic option for severely neutropenic patients with bacterial or fungal infections that are otherwise unresponsive to conventional therapy. Prior clinical studies suggest that patients receiving higher granulocyte doses achieve superior outcomes. Consequently, suboptimal donor stimulation and collection leading to lower granulocyte doses likely correlate with worse clinical outcomes. A retrospective analysis was conducted on mobilisation data from 312 granulocyte collections from healthy donors between January 2020 and May 2023. This study was performed in a single blood donor center exclusively supporting a comprehensive cancer center. Donors underwent stimulation with 480 mcg of filgrastim (granulocyte colony stimulating factor [G-CSF]) subcutaneously and 8 mg of dexamethasone orally administered 12 to 14 h before collection. The correlation between donor characteristics (age, gender, body weight (BW), body mass index (BMI), baseline haemoglobin (Hgb), and platelet (PLT) counts) and mobilisation efficiency (Δ WBC, defined as post-mobilisation WBC count-baseline WBC count) was examined to identify factors associated with enhanced mobilisation efficiency. Additionally, the impact of multiple donations on Δ WBC in repeat donors was assessed. The median donor age was 43 years (range 18-81), with 224 male and 88 female donors. Female donors exhibited significantly higher baseline PLT counts and post-mobilisation WBC counts. However, donor gender did not significantly affect Δ WBC. A negative correlation was observed between Δ WBC and age (r = -0.235, p = 0.001), with older donors (61-81 years) exhibiting significantly lower mobilisation efficiency. BW and BMI differences had no significant effect on Δ WBC. A positive correlation was identified between baseline PLT count and Δ WBC (r = 0.140, p = 0.014), with females having significantly higher baseline PLT counts (p = 0.0004). No correlation was found between Δ WBC and baseline Hgb (r = 0.004, p = 0.477). Repeat donors showed no statistically significant change in Δ WBC with subsequent donations, with a mean interval of 136.5 days between collections. Mobilisation efficiency was not impacted by donor BW or BMI suggesting that BW-based G-CSF stimulation is not essential for optimising WBC mobilisation. Rather, a fixed single dose of 480 mcg of G-CSF and 8 mg of dexamethasone was sufficient to mobilise donors, thus reducing the procedural costs and the potential risks for medication-related side effects. The positive correlation found between baseline PLT count and Δ WBC suggests that PLT count could be used as a potential predictor of mobilisation efficiency. Mobilisation response in up to four collections in repeat granulocytes donors was not affected in subsequent donations. However, sample size is a limitation, and more data is needed for a meaningful conclusion of whether frequent granulocyte donations are safe and effective.

Review on endoscopic capsules

This research provided an in-depth analysis of endoscopic capsules as an innovative application of the Internet of Things (IoT) in healthcare. The study revealed the importance of these systems in advancing gastrointestinal diagnostics due to their non-invasive nature and ability to provide comprehensive internal imaging. The work systematically investigated the device’s technical design, power management strategies, communication protocols, and how it performs its secure and efficient operations. Findings from this analysis highlighted the transformative impact of these capsules despite current constraints, such as battery limitations and procedural costs. Ultimately, this wide review confirmed that endoscopic capsules redefine medical diagnostics, fusing patient comfort with innovative technology. Moreover, as developments continue, these devices have promising potential to shape the future of intelligent, interconnected healthcare solutions.

Predictive factors for early mortality after EUS-guided gastroenterostomy in malignant gastric outlet obstruction

Background and study aim: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged as a potential treatment option for malignant gastric outlet obstruction (mGOO), with a relatively long duration of patency and low rate of reintervention. Its intrinsic risk for serious adverse events and high procedure cost mandates careful patient selection beyond the common safety profiles. This study aimed to assess for predictors of early post-EUS-GE mortality. Patients and methods: We conducted a retrospective analysis of all patients with unresectable mGOO who underwent EUS-GE. Predictive factors for postoperative 30-day mortality with crude and adjusted hazard ratios were examined using univariate and multivariate penalized likelihood Firth logistic regression analyses. Results: Technical and clinical success was achieved in 96.7% and 93.1% of the patients, respectively. The 30-day mortality rate after the procedure was 11.7%, and no procedural complications were observed. The 30-day mortality group had a significantly low rate of initial clinical success (66.7% vs. 96.2%, p=0.007). Univariate analysis identified significantly higher postoperative 30-day mortality in patients with poor baseline ECOG performance status scale (≥2) and ascites. The presence of grade 2 ascites was confirmed as an independent predictive factor in the multivariate analysis (adjusted hazard ratio 52.41, 95% confidence interval 1.55 to 1775.64, p=0.024). Conclusion: EUS-GE should be carefully considered for patients with ascites which was an independent predictor for early mortality after procedure in mGOO, especially those with grade 2 or higher level of ascites.

Facial Filler Injections– Questions Patients Ask and Where They Find Answers

Introduction: The most pressing questions patients ask about facial fillers and the sources to which patients are directed remain incompletely understood. Methods: The search engine optimization tool Ahrefs was utilized to extract Google metadata on searches performed in the United States. The most frequently asked questions were categorized by topic, while websites were categorized by authoring organization. JAMA benchmark criteria were used for website information quality assessment. Results: A total of 300 questions for the term “fillers” were extracted. The majority of search queries (24.0%) and monthly search volume (39.3%) pertained to procedural costs. The mean JAMA score for private practice sources (1.1 ± 0.57) was significantly lower than that of corporate sources (2.6 ± 0.55, p= 0.0003) but not significantly lower than academic pages (1.6 ± 1.34, p=0.483). With respect to monthly search volume, queries concerning lip fillers have been increasingly asked at a rate that exceeds other injection sites. Conclusion: Online searches for facial fillers often involve the topic of cost, and frequently direct patients to websites that contain inadequate information on authorship, attribution, disclosure and currency. When compared to other anatomic sites, search queries involving lip fillers have increased over the last three years.

Data‐driven framework for predicting the sorption capacity of carbon dioxide and methane in tight reservoirs

AbstractAs energy demand continues to rise and conventional fuel sources dwindle, there is growing emphasis on previously overlooked reservoirs, such as tight reservoirs. Shale and coal formations have emerged as highly attractive options due to their substantial contributions to global gas reserves. Enhanced shale gas recovery (ESGR) and enhanced coalbed methane recovery (ECBM) based on gas injection are advanced techniques used to increase the extraction of gas from shale and coal formations. One of the key challenges associated with these formations and their enhanced recovery methods is accurately predicting the sorption process and its profile. This is crucial because it affects how methane (CH4) and carbon dioxide (CO2) are stored and released from the rock, and it significantly impacts the evaluation of gas content and the potential productivity of these formations. Due to the high cost of experimental procedures and the moderate accuracy of existing predictive approaches, this study proposes various cheap and consistent data‐driven schemes for predicting the sorption of CH4 and CO2 in shale and coal formations. In this regard, three intelligent models, including generalized regression neural network (GRNN), radial basis function neural network (RBFNN), and categorical boosting (CatBoost), were taught and tested using more than 3800 real measurements of CH4 and CO2 sorption in shale and coal formations. To find automatically their appropriate control parameters and improve their prediction ability, RBFNN and CatBoost were evolved using grey wolf optimization (GWO). The obtained results exhibited the encouraging prediction capabilities of the suggested models. In addition, it was found that CatBoost‐GWO is the most accurate scheme with total root mean square (RMSE) and determination coefficient (R2) of 0.1229 and 0.9993 for CO2 sorption, and 0.0681 and 0.9970 for CH4 sorption, respectively. Additionally, this approach demonstrated its physical validity by respecting the real sorption tendencies with respect to operational parameters. Furthermore, the CatBoost‐GWO model outperforms recently published machine learning approaches. Lastly, the findings of this study offer a significant contribution by demonstrating that the suggested model can greatly improve the ease of estimating CO2 and CH4 sorption in tight formations, thereby facilitating the simulation of other parameters related to this process. © 2024 Society of Chemical Industry and John Wiley & Sons, Ltd.

HPB SO12 - Comparison of outcomes between stapled closure and sutured closure of pancreatic stump following robotic distal pancreatectomy

Abstract Background Postoperative pancreatic fistulas (POPFs) are associated with high patient mortality and morbidity. There are multiple approaches in managing pancreatic stumps following distal pancreatectomy. We compared the outcomes between sutured closure and stapled closure following robotic distal pancreatectomy and splenectomy, and the associated cost difference between the two techniques. Method We retrospectively analysed consecutive robotic distal pancreatectomy and splenectomy cases between October 2022 and January 2024 in a single United Kingdom tertiary hospital. Stapled closure was the initial standard approach. Sutured closure utilising 3/0 Prolene was regularly performed from July 2023. The study cohort was divided into these two groups and outcomes were compared. Primary outcome was POPF rates and secondary outcomes included postoperative length of stay (LOS), 30-day readmission rates and postoperative complications graded by Clavien-Dindo classification (CDC). Equipment costs for the respective procedures were obtained from hospital procurement team. Results 36 patients were reviewed; 14 (38.9%) were stapled and 22 (61.1%) were sutured. Patient characteristics including mean age, gender and ASA grade were similar in both groups. 23/36 (63.9%) patients had confirmed malignancy on postoperative histopathology – similar distribution in both groups. 6/14 (42.9%) in the stapled group vs 4/22 (18.2%) in the sutured group developed POPF Grade B (p=0.14). LOS, 30-day readmission and CDC complication rates were similar in both groups. Median costs were £2236.40 and £1541.86 in the stapled and sutured groups respectively. Conclusion Sutured closure of pancreatic stump yielded similar outcomes to stapled closure following robotic distal pancreatectomy, associated with a significant cost saving in favour of sutured closure.

Reducing healthcare costs by timely diagnosis and management in functional motor disorders.

Functional motor disorders (FMDs) are prevalent and highly disabling conditions among young adults, leading to reduced independence. Despite advancements in diagnosis and treatment, the economic burden of FMDs remains largely unknown. This study evaluates the impact of accurate FMDs diagnosis on direct healthcare costs within the Italian National Health System by comparing healthcare utilization and costs before and after diagnosis. This before-after study included 40 patients with a definite diagnosis of FMDs. Retrospective data on healthcare utilization, including diagnostic tests, specialist visits, hospitalizations, Emergency Room (ER) visits, and rehabilitation services, were collected from diaries and documents two years before and after diagnosis. Healthcare direct costs decreased by 67%, from an average of €4,467 [95% CI 3,604-5,329] to €1,461 [95% CI 945-1,976] after diagnosis. Hospitalization costs fell from €2,618 [95% CI 1,899-3,336] to €492 [95% CI 162-821], and ER costs dropped from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Diagnostic procedure costs decreased significantly, from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Specialist visit costs remained unchanged. Rehabilitation costs increased from €371 [95% CI 194-547] to €635 [95% CI 318-915], but this rise was not statistically significant. Accurate diagnosis of FMDs significantly reduces healthcare costs by minimizing unnecessary tests, hospitalizations, and ER visits while emphasizing rehabilitation. This highlights the economic and clinical benefits of improved diagnostic accuracy and specific multidisciplinary intervention. Investing in cost-effective diagnostic tools is crucial for earlier diagnosis and reducing delays.

EFFECTS OF HEALTH EXPENDITURE ON FOOD SECURITY STATUS OF RURAL HOUSEHOLDS IN OGUN STATE, NIGERIA

The study assessed the effect of health expenditure on the food security status of rural households in Ogun State, Nigeria. Multistage sampling procedure was used to select 120 rural households in the study area. Data was collected from the respondents with the aid of a semi-structured questionnaire complemented with an interview guide. Descriptive statistics, food security index, cost of illness procedure and binary logit regression model were the analytical techniques used for data analysis. Findings from the study revealed that majority (79.2%) of the respondent were male, married (90.8%), with a mean household size of 5 persons. Also, the mean age of the respondents was found to be 54 years with most of them involved in farming as their major occupation. Findings also revealed that majority of the rural households suffered from various illnesses such as malaria, waist/back pain, fever, high blood pressure, rheumatism and other illnesses with an average estimated cost of illness (₦45, 973.68 per month). The results of the food security status of the rural households revealed that a higher percentage (53.3%) of the rural households were food insecure. Factors found to significantly affect the food security status of the rural households were cost of illness (p<0.1) and other socio-economic variables such as education (p<0.1), income (p<0.05) and sex of the household head (p<0.01). Therefore, this study recommends that government should subsidize the cost of drugs and other medical expenses for poor households particularly those in the rural areas in order to reduce their financial burden on health care and increase their economic access to food.

Economic and Efficient: Introducing the Bifurcation-Invisible Sign in Endovascular Thrombectomy for Middle Cerebral Artery Occlusions.

Introduction Selecting thrombectomy techniques for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) significantly affects outcomes and costs. This study introduces the Bifurcation-Invisible (BI) sign identified on initial microcatheter angiogram in acute middle cerebral artery occlusions before endovascular thrombectomy. We aimed to evaluate whether this sign is associated with better angiographic outcomes using contact aspiration (CA) versus stent retriever (SR). Methods In this study, we reviewed 285 cases of acute M1-segment middle cerebral artery (M1-MCA) occlusions treated with stent retriever (SR) or contact aspiration (CA). Angiographic success was evaluated using modified Thrombolysis In Cerebral Infarction (mTICI) scores after the first attempt, clinical outcomes by 90-day modified Rankin Scale (mRS) scores, and procedural costs were analyzed. Categorical variables were analyzed using χ2 or Fisher's exact test, and continuous variables using Student's t-test or Mann-Whitney U test. Subgroup multivariate logistic analysis and interaction tests were conducted, with post-hoc analysis applying Bonferroni correction. Results BI-positive patients treated with CA had higher first-pass reperfusion rates (mTICI 2b-3: 64.0% vs. 41.3%, p = 0.005; Bonferroni-corrected p = 0.030) and 19.8% lower device costs (p < 0.05) than those treated with SR. BI-positive CA patients had higher first-pass reperfusion rates (mTICI 2b-3: 64.0% vs. 32.1%; p < 0.001; Bonferroni-corrected p = 0.002) and a 39.9% reduction in device costs (p < 0.05) than BI-negative patients. The interaction tests showed significant interactions between the presence of BI and contact aspiration for first-pass reperfusion rates (p = 0.007) and device costs (p ˂ 0.001). Conclusion The BI sign, a refined version of the BSO sign identified via microcatheter angiography, could guide the selection of contact aspiration, improving recanalization rates and reducing costs in MCA occlusions.

Fertility Preservation in Postpubertal Males Undergoing Cancer Treatment in a Middle-Income Country: Is it Possible Despite the Barriers?

Increased survival rates in childhood cancer have led to an emphasis on the importance of treatment-related infertility. Fertility preservation methods should be explained to every patient and their families (PaFs) before treatment. Establishing good communication with PaFs is crucial in this regard despite many barriers such as cultural and financial barriers. Routine feasibility of sperm preservation (SP) in adolescent males newly diagnosed with cancer was evaluated after the implementation of reimbursement for the procedure and storage by the national healthcare system. Males <18 years of age planned to undergo cancer treatment between 2021 and 2023 were included. Patient and their families were informed by the treating physician about the disease, treatment modality, side effects, the importance of SP, and the method. Information about the purpose and technique of SP was provided to the patient alone in a comfortable environment. Questions from PaFs were answered, and consent was obtained. The procedure and storage cost was covered by the social security institution. Seventeen patients (median age 15) (15 with bone/soft tissue sarcoma, 1 brain tumor, and 1 Hodgkin lymphoma) were included. There were no refusals for SP. Eleven patients were able to provide sperm samples. Of the 6 patients who could not provide sperm, 3 stated embarrassment, 2 anxiety, and 1 cancer-related pain. Increasing awareness among physicians about the importance of treatment-related infertility, allocating sufficient time to inform PaFs about fertility preservation, and providing information taking into account societal or socio-cultural factors will contribute to preventing treatment-related infertility. Establishing close communication with the Reproductive Health Center (RHC), along with the rapid and cost-free nature of the procedure, enhances success.

A Cohort Study Comparing Cost-Efficiency of Abdominal and Robotic Sacrocolpopexy

ObjectivesTo compare cost and reimbursement of robotic and abdominal sacrocolpopexy procedures to evaluate which approach may minimize costs while improving the hospital profit margin-. MethodsWe performed an IRB-exempt retrospective cohort study investigating all patients who underwent robotic or abdominal sacrocolpopexy at our hospital between July 1, 2018 and May 31,2022. Patient demographic, procedural, and post-operative course data were extracted via chart review including duration of procedure, time in operating room, complications, and length of hospital stay. The billing department provided information on estimated cost of stay and reimbursement rates. ResultsA total of 203 robotic and 291 abdominal cases were included in analysis. The groups had significant differences in demographics, including race and insurance status. Abdominal procedures were associated with lower costs ($7675.99 versus 8747.48, p<0.0001) and higher reimbursement rates ($16210.48 versus $10102.28, p<0.0001), with the total collected (reimbursement minus cost), or profit margin, differing significantly ($8534.50 versus $1354.80, p<0.0001). Discrepancies in reimbursement and profit remained after controlling for secondary procedures. Abdominal cases also had shorter average duration (129.9 vs. 168.4 minutes, p<0.0001). Abdominal sacrocolpopexy was associated with higher estimated blood loss (EBL) (109.2 vs. 97.9, p<0.0001) and longer hospital stay (26.3 versus 15.9 hours, p<0.0001). ConclusionsDespite longer hospital stays and slightly higher EBL, abdominal sacrocolpopexy appears to have lower costs and higher reimbursement rates than robotic sacrocolpopexy, with a higher profit margin for the hospital.

What is the True Cost of Motion Preservation? A Time-Driven Activity-Based Cost Analysis of Anterior Cervical Discectomy and Fusion versus Disc Replacement

Total disc replacement (TDR) has become a viable alternative to anterior cervical discectomy and fusion (ACDF) for select patients. Although most comparative studies have assessed outcomes, cost differences remain largely uninvestigated. This information is critical as we move towards value-based reimbursement. To address this knowledge gap, we used time-driven activity-based costing (TDABC) to compare total intraoperative costs between the two procedures. Total cost was divided into direct (personnel and supply cost) and indirect costs (administrative and overhead costs). Individual costs were determined through direct observation, electronic medical records, and through querying multiple departments (including business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented, in conjunction with process mapping of the intraoperative period. Total intraoperative costs were estimated for all ACDFs (n=810) and TDRs (n=54) from 2017 to 2022. Regression analyses were performed to identify factors associated with total cost. A total of 810 and 54 patients underwent one- and two-level ACDFs and TDRs, respectively. The average total intraoperative cost for an ACDF was $6,776 +/- $2,808, compared to $12,026 +/- $4,235 for TDR. Supply cost accounted for the majority of total cost for both procedures ($4,173 +/- $2,225 for ACDF and $9,532 +/- $4,010 for TDR). On multivariable linear regression analysis, TDR was associated with roughly $3,885 of additional cost compared to ACDF (p<0.001), as well as $4,072 in additional supply cost (p<0.001), most of which was driven by the higher cost of implants (p<0.001). TDABC is a highly useful methodology for estimating differences in true costs between procedures and determining cost drivers. TDRs were associated with an additional $3,885 of total intraoperative cost as compared to ACDFs, the majority of which was driven by the cost of implants.

Transcatheter closure of atrial septal defect (ASD) in adult and paediatric population without transoesophageal echocardiography/general anaesthesia

Abstract Background Transcatheter device closure is the preferred therapeutic option for ostium secundum atrial septal defect(OS-ASD). Standard practice is to perform it under transoesophageal echocardiography(TEE) guidance. However, TEE is performed under general anaesthesia (GA) and leads to increases in cost, procedural duration, ICU stay, total hospital stays, risk of oesophageal injury and complications of GA. Transthoracic echocardiography(TTE) is an excellent alternative and prior studies have shown it to be a safe alternative in paediatric population. In current study we analysed safety and efficacy of TTE-guided device closure of OS-ASD in all comer population irrespective of age, weight, defect size. Methods The study enrolled all patients who underwent device closure of OS-ASD between March 2017 and December 2023. All procedures were performed under LA for adults and conscious sedation for children. The device was placed under fluoroscopy guidance and position were confirmed on TTE. Procedural success, device, defect size ratio, procedural time, fluoroscopy time, complications, intensive care unit/hospital stay duration were analysed and compared with our own experience of 125 patients with TEE-guided closures before switching to complete TTE-guided procedure(before 2017). Results 340 patients underwent TTE-guided device closure of ASD. Procedure success was 97.4% with acceptable risk of major complications. Three(0.8%) had embolization into pulmonary artery, successfully operated surgically. Two had tamponade requiring drainage. In 9 patients, device could not be deployed despite multiple attempts and approaches. All of these had defect size of &amp;gt; 34mm and deficient IVC rim along with shorter (other than aortic) rim. Findings were compared with our own previous experience of TOE guided closure (practised before 2017). Compared to TOE group, TTE group had significantly lower total procedural duration (75±4 vs. 28 ±1 min; p &amp;lt; 0.01), intensive care unit stay (24±10 vs. 10.5±1 h; p &amp;lt; 0.01), and hospital (48±12 vs. 25.5±4h; p &amp;lt; 0.01) stay duration. Fluoroscopic time was similar in both. There was no mortality in either group. Major complications were comparable, TTE-guided group had less post-procedure complications of vomiting and headache. Additional findings of less pre-procedure fasting duration and early commencement of post procedure oral intake were noted in TTE group. Conclusion TTE-guided device closure of OS-ASD is a safe and feasible in all-comer population in experienced hands. It can definitely negate the use of TEE except in very poor echo window. The added advantages include utilization of physiological variations in PV/LV pressure during cough, Valsalva manoeuvres in awake patients. It definitely reduces the procedural duration, cost of procedure and dependence on GA and trained transoesophageal echocardiographer.

REPRODUÇÃO ASSISTIDA: DESAFIOS E AVANÇOS DAFERTILIZAÇÃO IN VITRO E INSEMINAÇÃO ARTIFICIAL COM PERSPECTIVAS ATUAIS E FUTURAS

Assisted human reproduction (AHR) is a set of medical techniques that enable human reproduction with assistance, contributing to cases of infertility, advanced age, same-sex couples, independent gestation, and family planning. The main techniques are artificial insemination and in vitro fertilization (IVF). This exploratory-descriptive study investigates the challenges faced by these couples, as well as recent advancements and future perspectives of these techniques. The analysis includes a review of recent literature, focusing on advancements such as improved ovarian stimulation protocols and embryo selection, as well as the impact of emerging technologies. The study also addresses the variable success rates, procedure costs, and ethical issues involved. It is expected that ongoing innovations will improve success rates, reduce risks, and enhance the accessibility of these treatments. Currently, the technique of intracytoplasmic sperm injection (ICSI) is widely used. Despite the challenges, AHR has enabled infertile couples to realize their dream of parenthood. With scientific and technological advancements, it is anticipated that AHR techniques will continue to evolve to benefit more and more couples wishing to have children.

No reimbursement policy and implantable loop recorders in the real world setting

Abstract Background Prolonged heart rhythm evaluation is indicated in patients with suspected arrhythmias. Routine electrocardiographic Holter monitoring is often associated with poor adherence and may lead to little to no clinically relevant findings. Implantable loop recorders (ILRs) are small, subcutaneous cardiac devices providing semi-continuous electrocardiographic recording. Despite strong evidence supporting their effectiveness, ILRs are yet to be fully reimbursed by the National Health Fund- the public insurer in Poland. Purpose We aimed to investigate the feasibility, as well as the diagnostic yield of ILRs in a real world setting of a tertiary cardiovascular center. Methods We retrospectively analyzed data of consecutive patients admitted for ILR implantation between March 2013 nad November 2023. Hospitalization and procedural costs were covered by the clinic's statutory and hospital funds and not by the National Health Fund, the public payer. All patients were remotely monitored for device follow-up. Baseline demographic characteristics, as well as data regarding observation period, clinical outcomes and safety were collected. Results Data for 51 ILR implants in 50 patients was assessed. Insertion success rate was 100% on first attempt with no complications. Mean age was 54,43 ±18,56 years old. 52,94% of patients were female. Coronary artery disease was present in 21,57% patients, hypertension in 50,98%, diabetes in 13,73%. The indications for ILR implantation were unexplained syncope (n= 42; 82,35%), palpitations (n= 16; 31,37%), ischemic stroke of unknown origin (n= 6; 11,76%), monitoring of ventricular arrhythmia (n= 2; 3,92%). Mean time between occurrence of first symptoms and ILR implantation was 80,86 ±112,95 months. Mean monitoring period was 1067,62 ±668,89 days. 23 (45,1%) patients had an actionable event detected. Mean time to clinical outcome was 190,34 ±514,85 days. Based on the obtained recordings, in 13 (25,49%) patients a cardiac electronic device was implanted and 6 (11,76%) underwent an electrophysiological procedure. Time to intervention was 435,17 ± 542,9 days and 338,8 ± 273,44 days, respectively. ILR prompted medication modification in 14 (27,45%) patients. Antiarrhythmic drugs were modified in 6 (11,76%) patients. Oral anticoagulation was initiated in 3 (5,88%) patients. Mean time to any pharmacotherapy modification was 654,68 ± 604,32 days. Skin infections occurred in 2 patients, leading to early device removal. Conclusions This is the first study to present a comprehensive evaluation of ILR patients in Poland, along with a substantial observation period. We report a high prevalence of treatable cardiac conditions in patients with previous unsuccessful diagnostic work up. In the light of the upcoming favourable changes in governmental healthcare policy, demonstrating evidence supporting ILR application in everyday clinical practice is crucial for advocating their wider utilization and reimbursement.

Single centre experience using vessel Fractional Flow Reserve (vFFR) and diagnostic performance compared with invasive Fractional Flow Reserve (FFR)

Abstract Background Fractional flow reserve (FFR) is a diagnostic gold standard in the functional assessment of coronary artery stenoses (1). Alternative invasive and non-invasive methods have been developed in an attempt to avoid limitations associated with FFR including added procedural risk, patient discomfort, time and cost. Vessel fractional flow reserve (vFFR) is a novel software using two angiographic projections to generate a 3D vessel reconstruction which has shown high diagnostic accuracy in predicting a positive FFR (2-4). Methods All patients undergoing coronary angiography between 01/10/2022 and 08/03/2023, where FFR was performed, were assessed. Patients were included where images met requirements necessary to use vFFR software. vFFR measurements were taken retrospectively by a single investigator and not used to inform patient care. Data were expressed as mean +/- standard deviation and %. The correlation of vFFR to FFR was compared using Pearson’s correlation coefficient. Receiving operator characteristic (ROC) area under the curve (AUC) analysis was used to determine diagnostic performance. Statistical analysis was performed using SPSS v27. Results 28 of 37 patients and 32 of 44 vessels were included and analysed with vFFR software. Excluded vessels were unsuitable due to insufficient frame rate or projection angulation during angiography. Mean age was 63 +/- 3.8 years and 75% of patients were male. Of 32 vessels assessed, 20 were LAD, 5 RCA, 5 LCx and 2 LMS. 29 of 32 vFFR values agreed with positive or negative FFR. Positive vFFR values were seen in all 15 vessels with positive FFR. 3 vessels received a positive vFFR where FFR values were negative. Mean vFFR was 0.76 +/- 0.1 and mean FFR was 0.81 +/- 0.09. vFFR correlated significantly with FFR (R=0.777, p&amp;lt;0.001). vFFR demonstrated good diagnostic accuracy in discriminating "positive" (&amp;gt;0.8) and "negative" (≤0.8) FFR with an AUC of 0.758 (95% CI 0.61-0.91, p&amp;lt;0.01). Conclusion vFFR correlated significantly with FFR and all positive FFR values also received positive vFFR values. vFFR demonstrated good diagnostic accuracy in predicting a positive FFR result. Thus, these data support a strategy of using a negative vFFR to avoid further testing.Pearson correlation of vFFR to invFFRROC curve: vFFR predicting invFFR

A cost-consequence analysis comparing three distinct cardiac ablation strategies for the treatment of paroxysmal atrial fibrillation

Abstract Background Cardiac ablation is a well-established treatment option for preventing atrial fibrillation (AF). While radiofrequency, cryo-energy, and laser energies are commonly employed in catheter ablation, they present the risk of potential damage to adjacent organs such as the oesophagus and phrenic nerve. To address these concerns, new technologies are being explored including pulsed field ablation (PFA), a non-thermal energy approach that employs high-voltage, short-duration pulses to selectively destroy target cells. Purpose The present analysis aims at: i) quantifying the short-term costs related to three ablation strategies for paroxysmal AF (PFA, radiofrequency ablation -RFA-, and cryo-balloon ablation -CRYO-), identify the cost drivers, and assess potential variations in resource consumption for each treatment alternative; ii) comparing the medium-term (1-year) economic implications of adopting the three alternatives, in terms of redo procedures (effectiveness) and complications (safety). Methods A cost-consequence model was developed to compare economic outcomes of the three ablation strategies for paroxysmal AF in the short- (during procedure) and medium-term (1-year). Resource consumption data during the procedure were collected by two European medical centres specialized in cardiac ablation (N=61 patients). For the medium-term analysis, costs were correlated to the effectiveness and safety of the procedures. The clinical data (i.e., redo and complication rates) considered in the model were retrieved from published literature. Costs and tariffs were collected from economic formularies of the respective hospitals. A scenario analysis was conducted to evaluate economic outcomes under various hypothetical difference in the prices of treatment kits. Results A significant difference was registered in terms of pre-procedural (mean±SD: 13.9±4.4 min for PFA, 20.1±7.6 min for CRYO and 20.5±7.7 min for RFA; ANOVA test p=0.003) and procedural time (skin-to-skin), favouring PFA over RFA and CRYO (53.6±26.8 min for PFA, 72.4±28.1 min for CRYO and 149.9±99.9 min for RFA; p&amp;lt;0.0001; Table 1). PFA was associated with lower procedural costs vs CRYO (-€400) and RFA (-€827). A similar economic advantage was observed in the medium-term (Table 2). The scenario analysis showed that PFA would be cost-saving vs CRYO (Δtotal costs ≤ 0) up to a price difference of +€881 (i.e., PFA kit is more expensive than CRYO kit), and similarly, up to a price difference of +€1,306 vs RFA. Above these thresholds, PFA would be considered cost-effective vs CRYO or RFA, due to its efficacy despite being more expensive. Conclusion In summary, PFA emerges as cost-effective or even cost-saving over CRYO and RFA, thanks to its faster execution, lower redo, and complications rate. Moreover, PFA time predictability would facilitate hospital planning. For a complete analysis, these benefits should be evaluated against the difference in acquisition costs among treatments.Procedural time by phase and techniqueCumulative savings per technique

Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias.

The extended totally extraperitoneal (eTEP) repair has several theoretical advantages over the traditional intraperitoneal onlay mesh (IPOM) repair for ventral hernias, including the use of less expensive non-barrier coated mesh and avoiding complications of intraperitoneal mesh. However, one area in need of further investigation is cost and clinical comparisons following robotic eTEP with IPOM. A retrospective matched cohort study was conducted of patients with midline ventral hernias undergoing robotic eTEP or IPOM at a single academic institution from November 2019-August 2023. Patients were matched based on demographics, hernia defect size, and whether they underwent concomitant procedures. Primary outcomes included supply costs. Secondary outcomes included operative time, length of stay, complications, recurrence, and inpatient opioid utilization. In total, 88 matched patients were included: 44 IPOM and 44 eTEP. Mean age was 57years, BMI 35kg/m2, and 54.5% were male. Hernia size was similar for both groups: 25 [6-73] cm2 for the IPOMs vs 40 [14-68] cm2 for eTEPs (p = 0.21). There was no significant difference in total supply costs between IPOMs and eTEPs: $2338 [2021-3249] vs $2082 [1619-3394] (p = 0.5) respectively. Mean operative time was significantly lower for IPOMs 159.6 ± 57.8min vs 198.0 ± 67.1 (p = 0.006), while the average length of stay was significantly longer for IPOMs: 1.7 ± 1.2days vs 1.2 ± 1.3days (p = 0.021). Total inpatient MME utilized was greater for IPOM: 61 [36-102] vs 29 [10-64] MME (p = 0.003). Postoperative complications and recurrence rate were similar. There is no difference in total supply costs between patients undergoing robotic IPOM and eTEP repairs for midline ventral hernias. Though this study did find significant differences in total inpatient MME utilized and length of stay, it is debatable whether these are clinically significant. Further research is needed to determine appropriate indications for eTEP over IPOM.