title: Postoperative costs associated with outcomes after cardiac surgery with extracorporeal circulation: role of antithrombin levels.
abstract: OBJECTIVE
  To study the impact on postoperative costs of a patient's antithrombin levels associated with outcomes after cardiac surgery with extracorporeal circulation.
  
  
  METHODS
  An analytic decision model was designed to estimate costs and clinical outcomes after cardiac surgery in a typical patient with low antithrombin levels (<63.7%) compared with a patient with normal antithrombin levels (≥63.7%). The data used in the model were obtained from a literature review and subsequently validated by a panel of experts in cardiothoracic anesthesiology.
  
  
  METHODS
  Multi-institutional (14 Spanish hospitals).
  
  
  METHODS
  Consultant anesthesiologists.
  
  
  RESULTS
  A sensitivity analysis of extreme scenarios was carried out to assess the impact of the major variables in the model results. The average cost per patient was €18,772 for a typical patient with low antithrombin levels and €13,881 for a typical patient with normal antithrombin levels. The difference in cost was due mainly to the longer hospital stay of a patient with low antithrombin levels compared with a patient with normal levels (13 v 10 days, respectively, representing a €4,596 higher cost) rather than to costs related to the management of postoperative complications (€215, mostly owing to transfusions). Sensitivity analysis showed a high variability range of approximately ±55% of the base case cost between the minimum and maximum scenarios, with the hospital stay contributing more significantly to the variation.
  
  
  CONCLUSIONS
  Based on this analytic decision model, there could be a marked increase in the postoperative costs of patients with low antithrombin activity levels at the end of cardiac surgery, mainly ascribed to a longer hospitalization.
authors.affiliation: Servicio de Anestesia, Cuidados Críticos y Terapia del Dolor, Hospital Universitario La Ribera, Alzira, Valencia, Spain. vmuedra@hospital-ribera.com
authors.forename: Vicente
authors.initials: V
authors.lastname: Muedra
authors.forename: Juan V
authors.initials: JV
authors.lastname: Llau
authors.forename: José
authors.initials: J
authors.lastname: Llagunes
authors.forename: Pilar
authors.initials: P
authors.lastname: Paniagua
authors.forename: Sonia
authors.initials: S
authors.lastname: Veiras
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Fernández-López
authors.forename: Carmen
authors.initials: C
authors.lastname: Diago
authors.forename: Francisco
authors.initials: F
authors.lastname: Hidalgo
authors.forename: Jesús
authors.initials: J
authors.lastname: Gil
authors.forename: Cristina
authors.initials: C
authors.lastname: Valiño
authors.forename: Enric
authors.initials: E
authors.lastname: Moret
authors.forename: Laura
authors.initials: L
authors.lastname: Gómez
authors.forename: Azucena
authors.initials: A
authors.lastname: Pajares
authors.forename: Blanca
authors.initials: B
authors.lastname: de Prada
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000097:blood*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000191:economics / Q000209:etiology; D001803:Blood Transfusion / Q000191:economics; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000191:economics*; D002316:Cardiotonic Agents / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003663:Decision Trees; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics; D005112:Extracorporeal Circulation / Q000009:adverse effects* / Q000191:economics*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007674:Kidney Diseases / Q000175:diagnosis / Q000191:economics / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000209:etiology; D011182:Postoperative Care / Q000191:economics*; D011183:Postoperative Complications / Q000097:blood / Q000191:economics / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000191:economics / Q000209:etiology; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000175:diagnosis / Q000191:economics / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D002316:Cardiotonic Agents