title: Comparison of costs and safety of a suture-mediated closure device with conventional manual compression after coronary artery interventions.
abstract: The aim of this study was to assess costs and safety of immediate femoral sheath removal and closure with a suture-mediated closure device (Perclose, Menlo Park, CA) in patients undergoing elective (PCI). A total of 193 patients was prospectively randomized to immediate arterial sheath removal and access site closure with a suture-mediated closure device (SMC; n = 96) or sheath removal 4 hr after PCI followed by manual compression (MC; n = 97). In the SMC group, patients were ambulated 4 hr after elective PCI if hemostasis was achieved. In the MC group, patients were ambulated the day after the procedure. In addition to safety, total direct costs including physician and nursing time, infrastructure, and the device were assessed in both groups. Total direct costs were significantly (all P < 0.001) lower in the SMC group. Successful hemostasis without major complication was achieved in all patients. The time to achieve hemostasis was significantly shorter in the SMC group (7.1 +/- 3.4 vs. 22.9 +/- 14.0 min; P < 0.01) and 85% of SMC patients were ambulated on the day of intervention. Suture-mediated closure allows a reduction in hospitalization time, leading to significant cost savings due to decreased personnel and infrastructural demands. In addition, the use of SMC is safe and convenient to the patients.
authors.affiliation: Department of Clinical Medicine, Division of Cardiology, Kantonsspital, St. Gallen, Switzerland. hans.rickli@kssg.ch
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
authors.forename: Martin
authors.initials: M
authors.lastname: Unterweger
authors.forename: Gabor
authors.initials: G
authors.lastname: Sütsch
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.forename: Markus
authors.initials: M
authors.lastname: Sagmeister
authors.forename: Peter
authors.initials: P
authors.lastname: Ammann
authors.forename: Franz W
authors.initials: FW
authors.lastname: Amann
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000295:instrumentation*; D001458:Bandages / Q000191:economics*; D003324:Coronary Artery Disease / Q000150:complications / Q000191:economics / Q000628:therapy; D003365:Costs and Cost Analysis; D004434:Early Ambulation; D004869:Equipment Safety / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006488:Hemostasis, Surgical / Q000191:economics / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011446:Prospective Studies; D013536:Suture Techniques / Q000191:economics* / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins