Coated prostheses are associated with prolonged inflammation in aortic surgery: a cost analysis.
This prospective study was conducted to compare inflammatory responses between patients receiving coated and uncoated vascular prostheses, and to examine their effect on length of stay and cost of patients undergoing abdominal aortic aneurysmectomy. Patients undergoing elective vascular reconstruction of an abdominal aortic aneurysm were assigned randomly to coated-graft or uncoated-graft groups (n = 20, for each group). Interleukin (IL)-6, granulocyte elastase, white blood cell count, C-reactive protein (CRP), and body temperature (BT) were prospectively recorded preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. In-hospital stay and hospitalized costs were also analyzed. IL-6 and CRP concentrations in the coated-graft group were higher than those in the uncoated-graft group (P = 0.01 and 0.05). BT was more frequently elevated >37 degrees C at POD 14 in the coated-graft group than in the uncoated-graft group (P =0.03). Discharge was delayed, and overall hospitalization cost was higher in the coated-graft group than in the uncoated group (17.6 vs. 13.5 days, and 2 010 000 vs. 1 780 000 yen, P = 0.006 and P = 0.002, respectively). Coated vascular prosthesis demonstrated more profound inflammatory reaction than noncoated prosthesis, postoperatively.
Shindo
Shunya
S
Second Department of Surgery, University of Yamanashi, Chuo-city, Yamanashi, Japan. sshindo@yamanashi.ac.jp
Motohashi
Shinya
S
Katsu
Masatake
M
Kaga
Shigeaki
S
Inoue
Hidenori
H
Matsumoto
Masahiko
M
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D001672:Biocompatible Materials / Q000009:adverse effects* / Q000191:economics; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism; D003362:Cost-Benefit Analysis; D005260:Female; D005549:Foreign-Body Reaction / Q000097:blood / Q000191:economics / Q000209:etiology* / Q000503:physiopathology; D005780:Gelatin / Q000009:adverse effects* / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay / Q000191:economics; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome
D001672:Biocompatible Materials; C508600:IL6 protein, human; D015850:Interleukin-6; D005780:Gelatin; D002097:C-Reactive Protein; D019272:Leukocyte Elastase