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Hamid A, Lamirault G, Gouëffic Y, Le Meur N. Duration of sick leave after same-day discharge for lower extremity arterial disease and varicose vein interventions in active population of French patients, 2013-2016: observational study. BMJ Open 2020; 10:e034713. [PMID: 32595150 PMCID: PMC7322330 DOI: 10.1136/bmjopen-2019-034713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess whether disparities in rates of same-day discharge for lower extremities arterial disease (5%) and varicose vein interventions (90%) are associated with the burden of postprocedural rehabilitation process, measured through the duration of sick leave. DESIGN Retrospective observational study using French National Health Insurance data in 2012-2016. SETTING The French National Health Data System (Système National des Données de Santé), which covers 98.8% of the 66 million people in the French population. PARTICIPANTS French workforce population aged 18 to 65 years old who underwent a first angioplasty with stent placement for lower extremities arterial disease (LEAD, n=30 238) or a first varicose vein intervention (n=265 670) between 2013 and 2016. MAIN OUTCOME MEASURES Duration and renewals of sick leave within 180 days after endovascular intervention, continuity of care and prescription indices to assess coordination among healthcare professionals after intervention associated with specific intervention settings: conventional (inpatient) or same-day discharge (outpatient). Association was estimated by multivariate negative binomial regressions adjusting for age, gender and comorbidities. RESULTS Outpatient settings decrease the incidence rate ratio (IRR) of the number of cumulated days of sick leave by 14% in both interventions. The increasing variety of prescribers decreases the IRR of cumulated days of sick leave and prescription renewals for varicose interventions by 25% and 21%, respectively, but increases them for LEAD interventions by 240% and 106%. Less coordination between healthcare specialists increases the IRR of cumulative days of sick leave and renewals by 37% and 29% for varicose, and 11% and 9% for LEAD interventions. CONCLUSIONS Low rates of outpatients in LEAD angioplasty does not seem related to the duration of sick leave. Outpatient setting reduces the duration of sick leave and their renewals, whatever the intervention. Coordination of healthcare professionals is a key element of interventions follow-up with pathology specificities.
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Affiliation(s)
- Asma Hamid
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, EHESP, Rennes, France
| | - Guillaume Lamirault
- Institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
- Institut du thorax, CHU Nantes, Nantes, France
| | - Yann Gouëffic
- Vascular Center, Groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Nolwenn Le Meur
- Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, EHESP, Rennes, France
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Zuckerman SL, Bhatia R, Tsujiara C, Baker CB, Szafran A, Cushing D, Aiken J, Tracy M, Mocco J, Ecker RD. Prospective series of two hours supine rest after 4fr sheath-based diagnostic cerebral angiography: Outcomes, productivity and cost. Interv Neuroradiol 2018; 21:114-9. [PMID: 25934785 DOI: 10.15274/inr-2014-10102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is no standard of care for catheter size or post-procedure supine time in cerebral angiography. Catheter sizes range from 4-Fr to 6-Fr with supine times ranging from two to over six hours. The objective of our study was to establish the efficacy, safety, and cost savings of two-hour supine time after 4-Fr elective cerebral angiography. A prospective, single arm study was performed on 107 patients undergoing elective cerebral angiography. All cerebral angiograms were performed with a 4-Fr sheath-based system without closure devices. Ten minutes of manual compression was applied to the femoral access site, with further compression held as clinically indicated. Patients were then monitored in a nursing unit for two hours supine and subsequently mobilized. Nursing discretion was allowed for earlier mobilization. Patients were called the next day to assess delayed hematoma and bleeding. Estimates of cost savings and productivity increases are provided. All patients ambulated in two hours or less. There were no strokes or vessel dissections. Five patients (4.7%) experienced a palpable hematoma, three patients (2.8%) experienced bleeding immediately following the procedure requiring further compression, and one patient (0.9%) experienced minor groin oozing at home. No patient required transfusion, thrombin injection, or endovascular/surgical management of a groin complication. A two-hour post-procedure supine time resulted in cost savings of $952 per angiogram and a total of $101,864. 4-Fr sheath based cerebral angiography with two-hour post-procedure supine time is safe and effective, and allows for a considerable increase in patient satisfaction, cost savings and productivity.
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Affiliation(s)
- Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ritwik Bhatia
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Crystiana Tsujiara
- Department of Radiology, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA
| | | | - Alex Szafran
- Surgery, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA
| | - Deborah Cushing
- Department of Radiology, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Judy Aiken
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Marilyn Tracy
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - J Mocco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert D Ecker
- Department of Radiology, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA Nursing, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA
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Zuckerman SL, Bhatia R, Tsujiara C, Baker CB, Szafran A, Cushing D, Aiken J, Tracy M, Mocco J, Ecker RD. Prospective series of two hours supine rest after 4fr sheath-based diagnostic cerebral angiography: Outcomes, productivity and cost. Interv Neuroradiol 2015. [DOI: 10.1177/inr-2014-10102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Clinical and economic evaluation of ambulatory endovascular treatment of peripheral arterial occlusive lesions. Ann Vasc Surg 2013; 28:137-43. [PMID: 24183403 DOI: 10.1016/j.avsg.2013.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ambulatory management of patients is an alternative to conventional hospitalization. In this study we evaluate the results of a prospective cohort study of patients receiving ambulatory endovascular treatment for peripheral arterial lesions. METHODS From June 2008 to October 2010, ambulatory management was proposed for endovascular treatment of peripheral arterial lesions. An arterial closure device (Angio-Seal(®); St. Jude Medical) was used. For ambulatory treatment, patients were prohibited from driving a vehicle at discharge, had to be accompanied the first night after the procedure, had to live <1 hour from a medical facility, had to be reachable by telephone the day after the intervention, and had to remain hospitalized in the event of a complication. The principal criterion was morbimortality at 1 month. Secondary criteria were clinical improvement, patency, complications related to the arterial closure, and costs evaluation at 1 month. RESULTS Forty-five patients were included and 50 ambulatory procedures were carried out. The patients presented with claudication (92%) or a critical ischemia (8%) of the lower extremities. All procedures were carried out by femoral puncture (retrograde in 94% and anterograde in 6% of the cases). The patients presented with iliac (68%) and femoropopliteal (64%) lesions. Lesions included stenoses (70%), thromboses (16%), and intrastent restenoses (14%). The rate of failure of ambulatory hospitalization was 16% (n = 8) without a serious undesirable event: 2 patients were hospitalized after a surgical conversion for iliac rupture and disinsertion of stent; 3 patients developed a hematoma during the intervention at the point of puncture; and in 3 cases the system of percutaneous closure failed. The mean duration of hospitalization was 1.36 ± 1.33 days. At 1 month, clinical improvement was observed in 97.5% of cases, with a primary patency of 100%. No perioperative rehospitalization or puncture site complications were observed. Ambulatory management made it possible to save 42 days of hospitalization, with associated costs of 10,971€, compared with conventional hospitalization. The additional costs related to use of the Angio-Seal amounted to 7427€. CONCLUSION Ambulatory endovascular treatment of patients presenting with peripheral arterial lesions is reliable and effective and may contribute to savings in healthcare spending.
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Park JK, Oh SJ, Shin JY. Delayed rupture of the iliac artery after percutaneous angioplasty. Ann Vasc Surg 2013; 28:491.e1-4. [PMID: 24161439 DOI: 10.1016/j.avsg.2013.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 05/04/2013] [Accepted: 05/08/2013] [Indexed: 11/16/2022]
Abstract
Rupture of the iliac artery during percutaneous angioplasty is a life-threatening condition that requires prompt diagnosis and treatment to rescue the patient. Recently, percutaneous angioplasty has become an outpatient procedure, but there is no reliable guideline for observation time in the hospital after percutaneous angioplasty. We describe a 67-year-old man with bilateral lesions in the iliac artery who experienced a delayed rupture of the iliac artery 2 days after percutaneous balloon angioplasty and placement of a self-expandable stent. The patient was successfully treated by endovascular intervention with a stent graft. In our department, percutaneous angioplasty is not performed in an outpatient clinic, and all patients are admitted to the hospital and observed for at least 3 days after percutaneous angioplasty. Because our patient was in the hospital when the iliac artery ruptured, prompt diagnosis and treatment were possible. Moreover, because appropriately sized stent grafts were prepared in the hospital, timely endovascular treatment could be performed, and the patient recovered successfully. From this case, we conclude that observing patients for a sufficient time in the hospital and preparing appropriately sized stent grafts are 2 important factors for the safety of patients who undergo percutaneous angioplasty.
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Affiliation(s)
- Jong Kwon Park
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Jin Yong Shin
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
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Future of vascular surgery is in the office. J Vasc Surg 2010; 51:509-13; discussion 513-4. [DOI: 10.1016/j.jvs.2009.09.056] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 11/20/2022]
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Comparison of costs of staged versus simultaneous lower extremity arterial hybrid procedures. Am J Surg 2008; 196:634-40. [DOI: 10.1016/j.amjsurg.2008.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 02/03/2023]
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O'Brien-Irr MS, Harris LM, Dosluoglu HH, Dayton M, Dryjski ML. Lower extremity endovascular interventions: Can we improve cost-efficiency? J Vasc Surg 2008; 47:982-7; discussion 987. [DOI: 10.1016/j.jvs.2007.11.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 11/23/2007] [Accepted: 11/23/2007] [Indexed: 11/24/2022]
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Gilliard N, Eggli Y, Halfon P. A methodology to estimate the potential to move inpatient to one day surgery. BMC Health Serv Res 2006; 6:78. [PMID: 16784523 PMCID: PMC1552063 DOI: 10.1186/1472-6963-6-78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 06/19/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The proportion of surgery performed as a day case varies greatly between countries. Low rates suggest a large growth potential in many countries. Measuring the potential development of one day surgery should be grounded on a comprehensive list of eligible procedures, based on a priori criteria, independent of local practices. We propose an algorithmic method, using only routinely available hospital data to identify surgical hospitalizations that could have been performed as one day treatment. METHODS Moving inpatient surgery to one day surgery was considered feasible if at least one surgical intervention was eligible for one day surgery and if none of the following criteria were present: intervention or affection requiring an inpatient stay, patient transferred or died, and length of stay greater than four days. The eligibility of a procedure to be treated as a day case was mainly established on three a priori criteria: surgical access (endoscopic or not), the invasiveness of the procedure and the size of the operated organ. Few overrides of these criteria occurred when procedures were associated with risk of immediate complications, slow physiological recovery or pain treatment requiring hospital infrastructure. The algorithm was applied to a random sample of one million inpatient US stays and more than 600 thousand Swiss inpatient stays, in the year 2002. RESULTS The validity of our method was demonstrated by the few discrepancies between the a priori criteria based list of eligible procedures, and a state list used for reimbursement purposes, the low proportion of hospitalizations eligible for one day care found in the US sample (4.9 versus 19.4% in the Swiss sample), and the distribution of the elective procedures found eligible in Swiss hospitals, well supported by the literature. There were large variations of the proportion of candidates for one day surgery among elective surgical hospitalizations between Swiss hospitals (3 to 45.3%). CONCLUSION The proposed approach allows the monitoring of the proportion of inpatient stay candidates for one day surgery. It could be used for infrastructure planning, resources negotiation and the surveillance of appropriate resource utilization.
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Affiliation(s)
- Nicolas Gilliard
- Anesthesiology Department, Centre hospitalier universitaire vaudois, 1005 Lausanne, Switzerland
| | - Yves Eggli
- Institut d'économie et de management de la santé, University of Lausanne, César Roux 19, 1005 Lausanne, Switzerland
| | - Patricia Halfon
- Institut universitaire de médecine sociale et préventive, University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
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Miracapillo G, Costoli A, Addonisio L, Breschi M, Pasquinelli K, Gemignani L, Severi S. Early mobilization after pacemaker implantation. J Cardiovasc Med (Hagerstown) 2006; 7:197-202. [PMID: 16645386 DOI: 10.2459/01.jcm.0000215273.70391.bf] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There are no international guidelines indicating how long a patient should stay strictly in bed after pacemaker implantation. In the present study, we tested a new protocol concerning the mobilization of patients 3 h after receiving a single or a dual-chamber pacemaker. METHODS Consecutive patients who underwent single or dual-chamber pacemaker implantation were randomized to a 3 or 24 h immobilization protocol. Only bipolar passive fixation leads were computed. After the implant, an elastic bandage was put on the homolateral shoulder of all patients for 24 h. A complete clinical and electronic follow-up was performed before discharge and repeated 2 months later. End-points considered were the displacement of the lead, high pacing thresholds (> 3.5 V/0.4 ms at the discharge or > 2.5 V/0.4 ms at the 2-month follow-up), sensing defects not corrigible by programming and clinical complications of the pocket RESULTS One hundred and thirty-four patients were included in the study: 57 in group A (mobilization after 3 h) and 77 in group B (24 h). In group A, one haematoma and two displacements occurred in three patients. In group B, we registered one haematoma, one subclavian vein thrombosis, three displacements and three high stimulation thresholds. No statistical differences were observed between the end-points of group A versus B. CONCLUSIONS The present study shows that an early mobilization protocol is feasible because no statistical differences resulted from the two groups of study as regards clinical outcome, complications and electronic measurements of the implanted devices, which have been followed up for 2 months.
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