Autologous reconstructions are associated with greater overall medium-term care costs than implant-based reconstructions in the Finnish healthcare system : A retrospective interim case-control cohort study

Purpose: Previous studies have mainly reported the short-term costs of different reconstruction techniques. Revision operations may increase costs in longer follow-up. Authors report medium-term data on different reconstruction methods. We hypothesised that the reconstruction method would affect not only the duration of reconstruction process but also total costs. Methods: The reconstruction database was reviewed from 2008 to 2019. Women with autologous (deep inferior epigastric perforator, transverse musculocutaneous gracilis and latissimus dorsi [LD] without implant) and implant-based (implant and LD with implant) reconstructions were included. Variables evaluated included age, body mass index, smoking, comorbidities, radiotherapy, complications and readmissions. Risk factors for multiple revision surgeries were analysed. Time to definitive reconstruction and related costs were also calculated. Results: In total, 591 patients with autologous reconstructions and 202 with implant-based reconstructions were included. The median follow-up time was 73 months. Definitive reconstruction was obtained in 443 days in implant-based reconstructions and in 403 days in autologous reconstructions (P = 0.050). Independent risk factors for multiple surgeries were younger age (P < 0.001) and comorbidity (P = 0.008). No statistically significant difference was observed in the rate of overall surgical procedures (P = 0.098), but implant-based reconstructions were more commonly associated with two or more planned operations (P = 0.008). Autologous reconstructions were associated with greater total cost ($22 052 vs.$18 329, P < 0.001). Conclusions: This review of reconstructions over a 12-year study period revealed that autologous reconstructions are associated with greater overall costs, but there is no statistically significant difference in reconstruction time or rate of surgical procedures. However, a full cost assessment between reconstructive techniques requires a much longer follow-up period.publishedVersionPeer reviewe

Day surgery in reduction mammaplasty – saving money or increasing complications?

Background: The benefits of reduction mammoplasty procedures have been reported previously. However, to control the rise in public healthcare costs, we need to find ways of conducting these procedures safely and more cost-effectively. Our aim was to examine whether reduction mammaplasty performed in an outpatient setting has comparable surgical complication rates to those performed in an inpatient setting. We also investigated whether any savings gained from day surgery are still present after any possible indirect costs are considered. Methods: The study population comprised 276 patients who underwent reduction mammaplasty in a single center between January 2019 and February 2021. Data were collected from patient medical records. The costs associated with the primary procedure and any possible additional expenses were calculated. Basic statistical comparisons were performed for propensity score-matched data. Results: Complication rates, readmissions, number of contacts to the health care system, and need for additional surgical interventions were comparable between outpatients and inpatients. The basic costs for outpatients were 2990 euros per patient and 3923 euros for inpatients. Total costs after possible extra expenses were lower in day surgery as it was markedly more cost-effective than patients treated as inpatients. Conclusions: Reduction mammaplasties can be safely performed in an outpatient setting. Moreover, the emergence of complications is comparable to those performed in an inpatient setting. An outpatient setting produced significant cost savings not only in the immediate costs of primary surgery but also in the costs associated with possible complications and extra contacts to the healthcare system.publishedVersionPeer reviewe

Investigation of the human oesophagus as a new monitoring site for blood oxygen saturation

Pulse oximeter probes placed peripherally may fail to give accurate values of arterial blood oxygen saturation (SpO2) when peripheral perfusion is poor. Since central blood flow may be preferentially preserved, the oesophagus was suggested as an alternative monitoring site. A reflectance oesophageal photoplethysmographic (PPG) probe and a multiplexed data acquisition system, operating simultaneously at two wavelengths and incorporating an external three-lead electrocardiogram (ECG) reference channel, has been developed. It has been used to investigate the suitability of the oesophagus as a possible monitoring site for SpO2 in cases of compromised peripheral perfusion. Oesophageal PPG signals and standard ECG traces were obtained from 16 anaesthetized patients and displayed on a laptop computer. Measurable PPG signals with high signal-to-noise ratios at both infrared and red wavelengths were obtained from all five oesophageal depths investigated. The maximum PPG amplitude occurred at 25 cm from the upper incisors in the mid-oesophagus. The measured pulse transit times (PTTs) to the oesophagus were consistent with previous measurements at peripheral sites and had a minimum value of 67 +/- 30 ms at a depth of 30 cm. There was broad agreement between the calculated values of oesophageal SpO2 and those from a commercial finger pulse oximeter

Filtering techniques for the removal of ventilator artefact in oesophageal pulse oximetry

The oesophagus has been shown to be a reliable site for monitoring blood oxygen saturation (SpO2). However, the photoplethysmographic (PPG) signals from the lower oesophagus are frequently contaminated by a ventilator artefact making the estimation of SpO2 impossible. A 776th order finite impulse response (FIR) filter and a 695th order interpolated finite impulse response (IFIR) filter were implemented to suppress the artefact. Both filters attenuated the ventilator artefact satisfactorily without distorting the morphology of the PPG when processing recorded data from ten cardiopulmonary bypass patients. The IFIR filter was the better since it conformed more closely to the desired filter specifications and allowed real-time processing. The average improvements in signal-to-noise ratio (SNR) achieved by the FIR and IFIR filters for the fundamental component of the red PPG signals with respect to the fundamental component of the artefact were 57.96 and 60.60 dB, respectively. The corresponding average improvements achieved by the FIR and IFIR filters for the infrared PPG signals were 54.83 and 60.96 dB, respectively. Both filters were also compared with their equivalent tenth order Butterworth filters. The average SNR improvements for the FIR and IFIR filters were significantly higher than those for the Butterworth filters

Sedentary behaviours and obesity in adults : the Cardiovascular Risk in Young Finns Study

Objective: Sedentary behaviour may contribute to the development of obesity. We investigated the relations between different types of sedentary behaviour and adiposity markers in a well-characterised adult population after controlling for a wide range of potential confounders. Design: Cross-sectional study. Setting: The Cardiovascular Risk in Young Finns Multicenter Study. Participants Sedentary time (TV viewing, computer time, reading, music/radio listening and other relaxation) was assessed with a questionnaire for 1084 women and 909 men aged 30-45 years. Other study variables included occupational and leisure-time physical activity, sleep duration, socioeconomic status, smoking, alcohol consumption, energy intake, adherence to the recommended diet, multiple individual food items, age and genetic variants associated with body mass index (BMI). Primary outcome measures BMI in kg/m(2) and waist circumference (WC in cm). Results: Of the different sedentary behaviour types, TV viewing was most consistently related to higher BMI and WC, both in men and women. One additional daily TV hour was associated with a 1.81 +/- 0.44 cm larger WC in women and 2 cm +/- 0.44 cm in men (both p Conclusions: Out of the different types of sedentary behaviour, TV viewing was most consistently associated with adiposity markers in adults. Partial dilution of these associations after adjustments for covariates suggests that the obesogenic effects of TV viewing are partly mediated by other lifestyle factors.Peer reviewe

Pulse oximetry in the oesophagus

Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO(2)) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Since central blood flow may be preferentially preserved, this review explores a new alternative site, the oesophagus, for monitoring blood oxygen saturation by pulse oximetry. This review article presents the basic physics, technology and applications of pulse oximetry including photoplethysmography. The limitations of this technique are also discussed leading to the proposed development of the oesophageal pulse oximeter. In the majority, the report will be focused on the description of a new oesophageal photoplethysmographic/SpO(2) probe, which was developed to investigate the suitability of the oesophagus as an alternative monitoring site for the continuous measurement of SpO(2) in cases of poor peripheral circulation. The article concludes with a review of reported clinical investigations of the oesophageal pulse oximeter