title: Evaluation of surgical procedures. Changing patterns of patient selection and costs in heart transplantation.
abstract: During the past 4 years we have observed a marked increase in costs of heart transplantation in our center. This trend coincides with a shift in our recipient population toward the more severely ill patients. The percentage of patients bound for the intensive care unit has doubled. In analyzing the components of cost, we find that the length of stay, both in special care and regular nursing units, accounts for most of the cost increase. In our study of outcomes we find no significant difference in survival, at 1 month and 1 year, between recipients operated on from the intensive care unit and those not in intensive care. We find that at 1 year after transplantation, approximately 80% of patients are rehabilitated, which we define as the ability to work or to go to school. Only 20% of patients are off disability rolls, however, primarily because of problems related to insurance and the cost of continuing care, including drugs. We conclude that the comprehensive evaluation of surgical procedures requires an approach that balances costs with results on a continuing and long-term basis.
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons, Office of Case Mix Studies of the Presbyterian Hospital, New York, NY.
authors.forename: K
authors.initials: K
authors.lastname: Reemtsma
authors.forename: G
authors.initials: G
authors.lastname: Berland
authors.forename: J
authors.initials: J
authors.lastname: Merrill
authors.forename: R
authors.initials: R
authors.lastname: Arons
authors.forename: C
authors.initials: C
authors.lastname: Evans
authors.forename: R
authors.initials: R
authors.lastname: Drusin
authors.forename: C R
authors.initials: CR
authors.lastname: Smith
authors.forename: E A
authors.initials: EA
authors.lastname: Rose
mesh_terms: D003365:Costs and Cost Analysis; D003422:Critical Care; D005069:Evaluation Studies as Topic; D016027:Heart Transplantation / Q000191:economics* / Q000401:mortality / Q000534:rehabilitation / Q000639:trends; D006801:Humans; D007902:Length of Stay; D015996:Survival Rate