Comparison of anaesthetic cost in open and laparoscopic appendectomy

Context: Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia.Aims: This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopicappendectomy under general anesthesia.Settings and Design: The design is retrospective and records of 379 patients who underwent open or laparoscopicappendectomy under general anesthesia, falling under the category of I‑III risk group according to the American Societyof Anesthesiologists (ASA) classification between the years 2011 and 2013, and aged 18-77.Subjects and Methods: Open (Group I) or laparoscopic (Group II) appendectomy operation under general anesthesiawere evaluated retrospectively by utilizing hospital automation and anesthesia observation records. This study evaluatedthe anesthesia time of the patients and total costs (Turkish Lira ₺, US dollar $) of anesthetic agents used (induction,maintenance), necessary medical materials (connecting line, endotracheal tube, airway, humidifier, branule, aspirationprobe), and intravenously administered fluids were evaluated.Statistical Analysis Used: We used Statistical Package for the Social Sciences software (SPSS version 17.0) forstatistical analysis.Results: Of the patients, 237 were males (62.53$) in Group I and 83.09 ± 26.85₺ (41.29 ± 13.34$) inGroup II (P > 0.05). A correlation was observed between cost and operation times (P = 0.002, r = 0.158).Conclusions: Although a statistical difference was not established in this study in terms of time and costs inappendectomy operations conducted as open and laparoscopically, changes may occur in time in market conditionsof drugs, patent rights, legal regulations, and prices. Therefore, we believe that it would be beneficial to update andrevise cost analyses from time to time.Keywords: Cost, cost comparison laparoscopic appendectomy, open appendectom

Access Rate to the Emergency Department for Venous Thromboembolism in Relationship with Coarse and Fine Particulate Matter Air Pollution

Particulate matter (PM) air pollution has been associated with cardiovascular and respiratory disease. Recent studies have proposed also a link with venous thromboembolism (VTE) risk. This study was aimed to evaluate the possible influence of air pollution-related changes on the daily flux of patients referring to the Emergency Department (ED) for VTE, dissecting the different effects of coarse and fine PM. From July 1st, 2007, to June 30th, 2009, data about ED accesses for VTE and about daily concentrations of PM air pollution in Verona district (Italy) were collected. Coarse PM (PM10-2.5) was calculated by subtracting the finest PM2.5 from the whole PM10. During the index period a total of 302 accesses for VTE were observed (135 males and 167 females; mean age 68.3±16.7 years). In multiple regression models adjusted for other atmospheric parameters PM10-2.5, but not PM2.5, concentrations were positively correlated with VTE (beta-coefficient = 0.237; P = 0.020). During the days with high levels of PM10-2.5 (≥75th percentile) there was an increased risk of ED accesses for VTE (OR 1.69 with 95%CI 1.13–2.53). By analysing days of exposure using distributed lag non-linear models, the increase of VTE risk was limited to PM10-2.5 peaks in the short-term period. Consistently with these results, in another cohort of subjects without active thrombosis (n = 102) an inverse correlation between PM10-2.5 and prothrombin time was found (R = −0.247; P = 0.012). Our results suggest that short-time exposure to high concentrations of PM10-2.5 may favour an increased rate of ED accesses for VTE through the induction of a prothrombotic state

Influence of Visual Information on Consent for Invasive Procedures in Intensive Care Unit

Objective: Patients hospitalized in Intensive Care Units (ICU) are critically ill. Sometimes informed consent for invasive procedures cannot be obtained from patients or relatives due to insufficient information. Methodology: Relatives of the patients who were being hospitalized in ICUs of state hospitals in 3 provinces in Eastern part of Turkey during year 2015, who were planned to undergo central venous catheter insertion, tracheostomy, and percutaneous gastroenterostomy (PGE) were asked to sign consent forms and these relatives were included in the study. The study groups were allocated as verbal (VeIG) and verbal‑visual information groups (ViIG). The next of kin who had the right for signing was included in the study. Results: Relatives of patients were interviewed for 512 invasive procedures. For the central venous catheterization, 91.6% of the VeIG (n = 166) and 97.6% of the ViIG (n = 166) accepted the central venous catheterization interventions (n = 332), for the tracheostomy, 65.3% of the VeIG (n = 49), 85.4% of the ViIG (n = 48) accepted the tracheostomy interventions (n = 97), and for the PGE, 23.8% of the VeIG (n = 42) and 48.8% of the ViIG (n = 41) accepted the PGE interventions (n = 83). A statistically significant difference was detected between VeIG and ViIG with regard to approval and refusal rates for different interventions. When approval‑refusal rates were compared with regard to education level, statistically significant difference was not detected between VeIG and ViIG with regard to approval and refusal rates. Conclusions: Using visual materials such as video in addition to verbal information provided an improvement in consent ratios regardless of education levels.Keywords: Comparative effectiveness research, informed consent, Intensive CareUnit, multimedi