63 research outputs found

    Hospital Costs Related to Early Extubation after Infant Cardiac Surgery

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    Background The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation rates after infant Tetralogy of Fallot (TOF) and coarctation (CoA) repair across participating sites by implementing a clinical practice guideline (CPG). The impact of the CPG on hospital costs has not been studied. Methods PHN CLS clinical data were linked to cost data from Children’s Hospital Association by matching on indirect identifiers. Hospital costs were evaluated across active and control sites in the pre- and post-CPG periods using generalized linear mixed effects models. A difference-in-difference approach was used to assess whether changes in cost observed in active sites were beyond secular trends in control sites. Results Data were successfully linked on 410/428 (96%) of eligible patients from 4 active and 4 control sites. Mean adjusted cost/case for TOF repair was significantly reduced in the post-CPG period at active sites (42,833vs.42,833 vs. 56,304, p<0.01) and unchanged at control sites (47,007vs.47,007 vs. 46,476, p=0.91), with an overall cost reduction of 27% in active vs. control sites (p=0.03). Specific categories of cost reduced in the TOF cohort included clinical (-66%, p<0.01), pharmacy (-46%, p=0.04), lab (-44%, p<0.01), and imaging (-32%, p<0.01). There was no change in costs for CoA repair at active or control sites. Conclusions The early extubation CPG was associated with a reduction in hospital costs for infants undergoing repair of TOF, but not CoA repair. This CPG represents an opportunity to both optimize clinical outcome and reduce costs for certain infant cardiac surgeries

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    Predictive modeling of defibrillation using hexahedral and tetrahedral finite element models: recent advances

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    Abstract Implanted cardioverter/defribillator (ICD) implants may be complicated by body size and anatomy. One approach to this problem has been the adoption of creative, extracardiac implant strategies using standard ICD components. Because data on safety or efficacy of such ad hoc implant strategies are lacking, we have developed image-based finite element models to compare electric fields and expected defibrillation thresholds (DFTs) using standard and novel electrode locations. In this article, we review recently published studies by our group using such models and progress in meshing strategies to improve efficiency and visualization. Our preliminary observations predict that they may be large changes in defibrillation thresholds with clinically relevant variations of electrode placement. Extracardiac ICDs of various lead configurations are predicted to be effective in both children and adults. This approach may aid both ICD development and patient-specific optimization of electrode placement, but the simplified nature of current models dictates further development and validation before clinical or industrial use
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