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A cost effective approach to surgical antibiotic prophylaxis.

https://arctichealth.org/en/permalink/ahliterature223292
Source
Can J Hosp Pharm. 1992 Aug;45(4):151-6
Publication Type
Article
Date
Aug-1992
Author
M M Pavan
D L Malyuk
Author Affiliation
Royal Columbian Hospital, New Westminster, British Columbia.
Source
Can J Hosp Pharm. 1992 Aug;45(4):151-6
Date
Aug-1992
Language
English
Publication Type
Article
Keywords
Appendectomy - adverse effects - economics
British Columbia
Cefazolin - economics - therapeutic use
Cefoxitin - economics - therapeutic use
Cost-Benefit Analysis
Drug Costs
Drug Therapy, Combination - economics - therapeutic use
Evaluation Studies as Topic
Hospital Bed Capacity, 500 and over
Humans
Interdepartmental Relations
Metronidazole - economics - therapeutic use
Pharmacy Service, Hospital - economics - statistics & numerical data
Premedication - economics
Questionnaires
Random Allocation
Research Design
Surgical Wound Infection - economics - prevention & control
Abstract
Cefoxitin has been the prophylactic antibiotic of choice for appendectomy and colorectal surgery at this institution. Recent information suggests that cefazolin and metronidazole given as a single intravenous preparation could be a cost-effective alternative to cefoxitin or cefotetan for surgical antimicrobial prophylaxis of uncomplicated appendectomies. This study was conducted to determine the efficacy, toxicity, and cost of the current antibiotic regimens used for prophylaxis of uncomplicated appendectomies, to evaluate the efficacy, toxicity and cost of the cefazolin plus metronidazole combination in uncomplicated appendectomies, and to facilitate a cooperative working relationship between the Departments of Pharmacy and General Surgery. Although the numbers involved were small, this study suggests that the cefazolin/metronidazole combination is cost-effective. It is suggested that research is warranted in evaluating combinations such as this as cost-effective alternatives to current therapy.
PubMed ID
10123058 View in PubMed
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The costs and effects of laparoscopic appendectomy in children.

https://arctichealth.org/en/permalink/ahliterature182169
Source
Arch Pediatr Adolesc Med. 2004 Jan;158(1):34-7
Publication Type
Article
Date
Jan-2004
Author
Hannu Lintula
Hannu Kokki
Kari Vanamo
Hannu Valtonen
Matti Mattila
Matti Eskelinen
Author Affiliation
Department of Paediatric Surgery, Kuopio University Hospital, Finland. hannu.lintula@kuh.fi
Source
Arch Pediatr Adolesc Med. 2004 Jan;158(1):34-7
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Appendectomy - adverse effects - economics - methods
Child
Child, Preschool
Cost-Benefit Analysis
Finland
Humans
Laparoscopes - economics
Laparoscopy - adverse effects - economics - methods
Prospective Studies
Abstract
Laparoscopic procedures are performed commonly in children. In general, the cost containment of laparoscopic surgery in children has not been evaluated.
To compare the costs of laparoscopic appendectomy with those of open appendectomy.
Prospective clinical trial between November 1, 1997, and April 30, 2000. For analysis, cost of supplies, operation room use, and recovery in the hospital and after discharge was evaluated. Costs common to both groups were not determined.
Operations performed in a university hospital.Patients Eighty-seven children aged 4 to 15 years who underwent appendectomy for suspected appendicitis. Patients were randomized to laparoscopic or open appendectomy. Intervention Laparoscopic appendectomies performed with the same standard set of reusable equipment.
Cost surplus of the laparoscopic procedure and recovery after surgery were evaluated, to determine the costs and effects of laparoscopic appendectomy compared with those of open appendectomy in children.
Excess operating and complication costs per procedure were 96 euros (EUR) in laparoscopic appendectomy. The increased operative expenses were offset by a shorter hospital stay, resulting in a marginal difference of 53 EUR in itemized total costs between the 2 procedures (total cost, 1023 EUR in the laparoscopic appendectomy group and 970 EUR in the open appendectomy group). After laparoscopic appendectomy, children returned to school and sports earlier than those who had had an open appendectomy.
Laparoscopic appendectomy was marginally more expensive, but it allowed earlier return to normal daily activities than open appendectomy.
Notes
Comment In: Arch Pediatr Adolesc Med. 2004 Jan;158(1):11-214706949
PubMed ID
14706955 View in PubMed
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Impact of an outpatient appendectomy protocol on clinical outcomes and cost: a case-control study.

https://arctichealth.org/en/permalink/ahliterature140755
Source
J Am Coll Surg. 2010 Dec;211(6):731-7
Publication Type
Article
Date
Dec-2010
Author
Luc Dubois
Kelly N Vogt
Ward Davies
Christopher M Schlachta
Author Affiliation
Department of Surgery, Division of General Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada. ldubois@uwo.ca
Source
J Am Coll Surg. 2010 Dec;211(6):731-7
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Ambulatory Care - economics - methods - standards
Ambulatory Surgical Procedures - economics - standards
Appendectomy - adverse effects - economics - methods - standards
Appendicitis - surgery
Canada
Case-Control Studies
Comorbidity
Emergencies
Female
Humans
Laparoscopy
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Admission
Patient Discharge
Young Adult
Abstract
Although elective outpatient surgery is commonplace, surgeons remain hesitant to discharge patients the same day after emergent surgery. We created a formal protocol to select patients for early discharge after laparoscopic appendectomy for acute appendicitis, and we assessed its safety and potential cost savings.
We matched patients who were discharged early from the recovery room with similar patients from a control group on the basis of age ± 3 years, presence or absence of a comorbidity, laparoscopic procedure, and nonperforated appendicitis; we compared them to assess the impact of early discharge on morbidity, return visits to the emergency room, and total cost incurred by our institution.
During the first year of our protocol, 72 of 161 (45%) patients who presented with acute appendicitis and underwent appendectomy were discharged early, with a median post-operative length of stay of 4.7 hours. When compared with matched controls, patients discharged early had similar complication rates (4.3% early group vs 7.1%, p = 0.72) and number of postoperative visits to the emergency room (11.4% vs 11.4%, p = 0.8), but had a reduced median length of stay (4.7 vs 16.2 hours, p
Notes
Comment In: J Am Coll Surg. 2011 Jul;213(1):197; author reply 197-821700198
PubMed ID
20846883 View in PubMed
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