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The impact of revascularization surgery upon hospital costs in patients with angina pectoris
ABSTRACTS
ADDENDUM
THE IMF'ACT OF REVASCULAFXZATION SURGERYUPON HOSPITAL COSTS IN PATIENTSWITH ANGINAPECTORIS John J. Collins,Jr., MD, FACC; WilliamY. Tucker,MD; Gary Kopf, MD; J. KennethKoster, Jr., MD; Roger B. B. Mee, MD; LawrenceH. Cohn, MD, FACC, HarvardMedical School,Boston,Massachusetts This study comparesthe expenseof revascularization surgery with the cost of continuedmedicalmanagementin patientswith angina pectoris. A consecutivegroup of102 patientswith angina pectoris(excludingpatientswith predominantcongestiveheart failure,shock, and valvular heart disease)operatedupon betweenApril 1974 and April 1975 was selectedfor analysis. Hospitalizations for noncardiacillnessand diagnosticangiographywere excluded. There were 2 hospitaldeaths and no late deaths,leaving100 patientswhose course for 2 years before and 2 years after surgerycould be compared. Within this group were 81 men, aged 28 to 68 (m), and 19 women, aged 37 to 69 (56.0). Significantobstruction was present in 3 or more vessels in 56 patients,2 vessels in 36, and 1 vessel in 8. There were 32 patients receiving3 grafts, 52 with 2 grafts,and 13 with 1 graft. During the 2 years before operation,54 hospitalizationsfor cardiacproblemswere needed. There were 27 patientswith 1 hospitalization, 17 with 2 admissions, and 10 with 3 or more admissions. In the 2 years after operation,there were only 10 hospitalizations for cardiac problems. Postoperativehospitaldays averaged 5.9 days/yr/ptfewer than during the 2 years prior to operation,representingan estimatedsaving of $2000/pt/ yr. At this rate the 98000 averagehospitalization cost for revascularization would be amortizedin 4 years. These data suggestthat coronarybypass may be a less expensivetreatmentthan medical therapy for patients with severe angina pectoris.
VALVBRRPIACRMRNT IN CHILDRRN ANDAIXILRSCBNTS Robert A. Mathewn. MD; Sang C. Park, MD, FACC; William 11. Ncchee, MD, FACC; Cota C. Lcnox, MD,FACC;J.B. Zubcrbuhlcz, MD, FACC; P. JAY Pricker, MD; Ralph D. Slewerr, MD, FACC; Robert L. Herdeety, MD, FACC; David B. Lerberg. MD, Henry T. Bahneon. MD. FACC, Children’6 Hoepital of Pittsburgh 6 University of Pittsburgh School of Medicine, Pitteburgh, PA. Replacement of dieeased heart valvee haa advanced over the pact decade to become the treatment of choice in many adulta. In children and adolercents, valve replacement has been ueed in our institution only when other surgical procedures are Ineffective. Over the p&et ten yearn 27 patient6 have received 31 artificial valvee. Thirteen patients (49%) had eevere rhematic valvular heart dleeae) many with two valve involvement. The remainder had congenital valvular aortlc etenoela or lneufficiency, congenital or acquired mitral lneufflclency, lbeent pulaonlc valve with tetralogy of Fallot or “corrected” tranepoeltlon of the great arteries with left-sided A-V valve lnThe Bjotk-Shlley valve wae ured amet freaufflclency. quently In the aortlc poeltion and the Beall proetheelr There vere eight de&he (30%); In the mitral poeitlon. five lnnedlately port-operatively and three within a yeer Two children under lge six and four uuderafter rurgery. going double valve surgery died. The yO~&Blt rurvivor had valve replacement at 64 yeere. Follov-up ranged fra rix to 79 months, averaging 30 months. All eurvivorr returned to normal activity and are free of cardiac ryqtou Hemarthroeia secondary to lntlcoegulation vae eeen in three patience (11%). Our experience In the pediatric age group euggeete thet velve replacement can be performed at higher riok than the adult but at remoneble rlrk for thoee patlente in whom valvulotomy or valvuloplaety ie expected to be ineffectlq
February 1979
The American Journal of CARDIOLOGY
Volume 41
447
ADDENDUM
THE IMF'ACT OF REVASCULAFXZATION SURGERYUPON HOSPITAL COSTS IN PATIENTSWITH ANGINAPECTORIS John J. Collins,Jr., MD, FACC; WilliamY. Tucker,MD; Gary Kopf, MD; J. KennethKoster, Jr., MD; Roger B. B. Mee, MD; LawrenceH. Cohn, MD, FACC, HarvardMedical School,Boston,Massachusetts This study comparesthe expenseof revascularization surgery with the cost of continuedmedicalmanagementin patientswith angina pectoris. A consecutivegroup of102 patientswith angina pectoris(excludingpatientswith predominantcongestiveheart failure,shock, and valvular heart disease)operatedupon betweenApril 1974 and April 1975 was selectedfor analysis. Hospitalizations for noncardiacillnessand diagnosticangiographywere excluded. There were 2 hospitaldeaths and no late deaths,leaving100 patientswhose course for 2 years before and 2 years after surgerycould be compared. Within this group were 81 men, aged 28 to 68 (m), and 19 women, aged 37 to 69 (56.0). Significantobstruction was present in 3 or more vessels in 56 patients,2 vessels in 36, and 1 vessel in 8. There were 32 patients receiving3 grafts, 52 with 2 grafts,and 13 with 1 graft. During the 2 years before operation,54 hospitalizationsfor cardiacproblemswere needed. There were 27 patientswith 1 hospitalization, 17 with 2 admissions, and 10 with 3 or more admissions. In the 2 years after operation,there were only 10 hospitalizations for cardiac problems. Postoperativehospitaldays averaged 5.9 days/yr/ptfewer than during the 2 years prior to operation,representingan estimatedsaving of $2000/pt/ yr. At this rate the 98000 averagehospitalization cost for revascularization would be amortizedin 4 years. These data suggestthat coronarybypass may be a less expensivetreatmentthan medical therapy for patients with severe angina pectoris.
VALVBRRPIACRMRNT IN CHILDRRN ANDAIXILRSCBNTS Robert A. Mathewn. MD; Sang C. Park, MD, FACC; William 11. Ncchee, MD, FACC; Cota C. Lcnox, MD,FACC;J.B. Zubcrbuhlcz, MD, FACC; P. JAY Pricker, MD; Ralph D. Slewerr, MD, FACC; Robert L. Herdeety, MD, FACC; David B. Lerberg. MD, Henry T. Bahneon. MD. FACC, Children’6 Hoepital of Pittsburgh 6 University of Pittsburgh School of Medicine, Pitteburgh, PA. Replacement of dieeased heart valvee haa advanced over the pact decade to become the treatment of choice in many adulta. In children and adolercents, valve replacement has been ueed in our institution only when other surgical procedures are Ineffective. Over the p&et ten yearn 27 patient6 have received 31 artificial valvee. Thirteen patients (49%) had eevere rhematic valvular heart dleeae) many with two valve involvement. The remainder had congenital valvular aortlc etenoela or lneufficiency, congenital or acquired mitral lneufflclency, lbeent pulaonlc valve with tetralogy of Fallot or “corrected” tranepoeltlon of the great arteries with left-sided A-V valve lnThe Bjotk-Shlley valve wae ured amet freaufflclency. quently In the aortlc poeltion and the Beall proetheelr There vere eight de&he (30%); In the mitral poeitlon. five lnnedlately port-operatively and three within a yeer Two children under lge six and four uuderafter rurgery. going double valve surgery died. The yO~&Blt rurvivor had valve replacement at 64 yeere. Follov-up ranged fra rix to 79 months, averaging 30 months. All eurvivorr returned to normal activity and are free of cardiac ryqtou Hemarthroeia secondary to lntlcoegulation vae eeen in three patience (11%). Our experience In the pediatric age group euggeete thet velve replacement can be performed at higher riok than the adult but at remoneble rlrk for thoee patlente in whom valvulotomy or valvuloplaety ie expected to be ineffectlq
February 1979
The American Journal of CARDIOLOGY
Volume 41
447