title: Short-stay intensive care after coronary artery bypass surgery: randomized clinical trial on safety and cost-effectiveness.
abstract: OBJECTIVE
  To evaluate the safety and cost-effectiveness of short-stay intensive care (SSIC) treatment for low-risk coronary artery bypass patients.
  
  
  METHODS
  Randomized clinical equivalence trial.
  
  
  METHODS
  University Hospital Maastricht, the Netherlands.
  
  
  METHODS
  Low-risk coronary artery bypass patients.
  
  
  METHODS
  A total of 600 patients were randomly assigned to undergo either SSIC treatment (8 hrs of intensive care treatment) or control treatment (care as usual, overnight intensive care treatment).
  
  
  METHODS
  The primary outcome measures were intensive care readmissions and total hospital stay. The secondary outcome measures were total hospital costs, quality of life, postoperative morbidity, and mortality. Hospital costs consisted of the cost of hospital admission or admissions and outpatient costs.
  
  
  RESULTS
  The difference in intensive care readmission between the two groups of 1.13% was very small and not significantly different (p = .241; 95% confidence interval, -0.9% to 2.9%). The total hospital stay (p = .807; 95% confidence interval, 1.2 to -0.4) and postoperative morbidity were comparable between the groups. The SSIC group's quality of life improved more compared with the control group's quality of life (p = .0238; 95% confidence interval, 0.0012 to 0.0464). The total hospital costs for SSIC were significantly lower (95% confidence interval, -1,581 to -174) compared with those for the control group (4,625 and 5,441, respectively). The estimated incremental cost-effectiveness ratio (cost/delta quality-adjusted life months) thus showed the dominance of SSIC. Bootstrap and sensitivity analyses confirm the robustness of the study findings.
  
  
  CONCLUSIONS
  Compared with usual care, SSIC is a safe and cost-effective approach. SSIC can be considered as an alternative for conventional postoperative intensive care treatment for low-risk coronary artery bypass graft patients.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, Netherlands.
authors.forename: Ghislaine A P G
authors.initials: GA
authors.lastname: van Mastrigt
authors.forename: John
authors.initials: J
authors.lastname: Heijmans
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Fransen
authors.forename: Paul
authors.initials: P
authors.lastname: Roekaerts
authors.forename: Gemma
authors.initials: G
authors.lastname: Voss
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics* / Q000379:methods; D005260:Female; D006085:Graft Survival; D017721:Hospital Costs; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D016037:Single-Blind Method; D016896:Treatment Outcome