Análisis coste efectividad a 2 años del tratamiento quirúrgico de la hiperplasia benigna de próstata mediante vaporización fotoselectiva de la próstata con GreenLight–PhotoVaporization 120 W versus resección transuretral de la próstata

IntroductionTransurethral resection of the prostate is the gold standard of surgical treatment of lower urinary tract symptoms associated to benign prostate hyperplasia. The new Green Light Photovaporization has been shown to be an alternative that is as effective for this condition as the transurethral resection of the prostate.ObjectivesTo compare the efficiency of Green Light Photovaporization 120 W versus transurethral resection of the prostate in the treatment of benign prostate hyperplasia (BPH) in a 2-year time horizon from the perspective of the Spanish health service perspective.MethodsA cost utility analysis was performed retrospectively with the data from 98 patients treated sequentially with transurethral resection of the prostate (n: 50) and Green Light Photovaporization 120 W (n: 48). A Markov model was designed to estimate the cost (2012 €) and results (quality adjusted life years) in a 2-year time horizon.ResultsThe total cost associated to Green Light Photovaporization 120 W treatment was less (3,377 €; 95% CI: 3,228; 3,537) than that of the transurethral resection of the prostate (3,770 €; 95% CI: 3,579; 3,945). The determining factor of the cost was the surgical phase (difference: −450 €; 95% CI: −625; −158) because admission to hospital after surgery was not necessary with the GreenLight-PhotoVaporization.ConclusionsSurgical treatment of BPH patients with GreenLight-PhotoVaporization 120 W is more efficient than transurethral resection of the prostate in the surgical treatment of benign prostate hyperplasia as it has similar effectiveness and lower cost (−393 €; 95% CI: −625; −158).     

Statin discontinuation and mortality in an older adult population with traumatic brain injury: A four-year,multi-centre,observational cohort study

IntroductionStatin discontinuation has been investigated in a wide range of diseases and injuries, but there is a paucity of data in the older adult population with traumatic brain injury (TBI). The purpose of this study was to re-examine the extent to which early discontinuation of pre-injury statin (PIS) therapy increases the risk of poor patient outcomes in older adult patients suffering a TBI.MethodsThis was a retrospective observational cohort study of adult trauma patients with a blunt TBI across three trauma centres over four years. Patients were excluded because of no PIS use, age <55 years, or a hospital length of stay (LOS) less than three days. Patients found to be intentionally discontinued from statin therapy within 48 h of hospital admission for injury-related reasons were excluded. The primary and secondary outcomes were in-hospital mortality and a hospital LOS ≥1 week. Outcomes were analysed using logistic regression.ResultsThere were 266 patients in the continuation group, and 131 in the discontinuation group. The statin discontinuation group had a significantly higher proportion of patients with a moderate or severe head injury, intubation in emergency department (ED), and disposition to the intensive care unit or operating room. Overall, 23 (6%) patients died while in the hospital. After adjusting for ED Glasgow coma scale, the odds of dying in the hospital were not significantly larger for patients having been discontinued from PIS, compared to those who were continued (OR = 1.75, 95%CI = 0.71–4.31, p = 0.22). Among patients who received an in-hospital statin, the median (interquartile range) time between hospital admission and first administration of statin medication did not differ between patients who died and those who survived (22.8 h [10.96–28.91] vs. 22.9 h [11.67–39.80], p = 0.94). There were no significant differences between study groups in the proportion of patients with a hospital length of stay >1 week (continuation = 29% vs. discontinuation = 36%, p = 0.19).ConclusionWe did not observe a significantly increased odds of in-hospital mortality following PIS discontinuation, compared to PIS continuation, in an older adult population with TBI. It remains to be seen whether statin discontinuation is a proxy variable for injury severity, or whether it exerts deleterious effects after injury.     

Evolution of costs of care for cystic fibrosis patients after clinical guidelines implementation in a French network

ObjectivesThe aim of this study was to evaluate how advances in CF management in France between 2000 and 2003 impacted CF-related costs.MethodsThe analysis of direct medical costs was done in 2000 and 2003 from the perspective of the French national healthcare insurance system. The patients, 65 in 2000 and 64 in 2003, were followed-up in one pediatric and one adult CF reference center (CFRC). We quantified and valued CF-related home and hospital care costs.ResultsWe found an average cost of €16 474/patient/year in 2000, and €22 725 in 2003 (based on the 2003 euro value). Hospital care increased from 15% of the total cost in 2000 to 22% in 2003. Medications accounted for 45% of the total cost for the two periods, with an average cost of €7229/patient/year in 2000 and €10 336 in 2003. Home intravenous antibiotic therapy accounted for 20% of the total cost for the two periods.ConclusionsWe highlighted an increase in CF care costs between 2000 and 2003, which might be related to the changes in practice patterns that followed guidelines implementation, such as the use of new medications (dornase alpha and tobramycin) and more frequent follow-up in the CFRC.     

Estudio multicéntrico de costes de 2 técnicas quirúrgicas: láser GreenLight XPS 180 W vs resección transuretral de la próstata

ObjectiveTo analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180¦W versus the gold standard transurethral resection of the prostate.MethodsA multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS = 15, Qmax = 15 mL/seg and a prostate volume of 40-80 mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications.ResultsA total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October, 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (P = .67). The average direct cost per patient was reduced by € 114 in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: € 1,209; P < .001) but was lower in the post-surgical phase (difference: € –1,351; P < .001).ConclusionsThe GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.     

Eficacia y eficiencia de un programa especial para la disminución de la lista de espera de cirugía bariátrica en un hospital terciario

IntroductionBariatric surgery is one of the most common surgical practices in Spain. However, this procedure currently has longest delay on surgical waiting lists (SWL). We have developed a special surgical program that aims to reduce this waiting list and to assess the economic and clinical repercussions in a high-volume bariatric surgery unit.MethodsA three-month prospective study was carried out comparing outcomes, results and perioperative resources consumed for 45 patients who underwent bariatric surgery. The patients were divided into 2 groups: patients who underwent the standard procedure in the operating room, and patients treated in the special program. Epidemiological, healthcare and economic factors were taken into account.ResultsTwo homogeneous groups of patients were operated on, successfully reducing the SWL. Morbidity was similar in both groups and the average cost of the surgeries performed was €5,331.40; in the standard group, the cost was €5,372.50 ± €798.10, and the cost of the special program group was €5,290.30 ± €685.10, with no significant differences.ConclusionsIn hospitals with a high volume of bariatric surgery, it is feasible to incorporate special surgical programs that are able to reduce surgical waiting lists, while maintaining quality criteria and without incurring a greater expense to the healthcare system.     

Medico-economic study of the management of hepatocellular carcinoma by chemo-embolization

PurposeThis study has two aims. The first is to compare conventional lipiodol chemo-embolization (Trans Arterial Chemo-Embolization – TACE) to one using pre-loaded particles (Trans Arterial Chemo-Embolisation-Drug Eluted Bead – TACE-DEB) using a cost minimization study. The second is to define the fundable nature of TACE-DEB and the conditions under which it is cost-effective.Materials and methodsRetrospective study of patients treated by chemo-embolization (n = 31: TACE; n = 32: TACE-DEB) during the year 2010. The cost minimization study was conducted from the hospital perspective. Direct medical costs were calculated and compared using the readjusted ENCC (National Studies of Costs by Common Methodology) method. The affordability of the two techniques and definition of a cost-effective hypothesis (break-even point) were also established.ResultsAll DRGs combined, lengths of stay (TACE: 4.90 ± 3.36; TACE-DEB: 5.03 ± 3.36) does not change significantly. An average upper mean cost for TACE-DEB is described (TACE: 2869.05 €; TACE-DEB: 3960.10 €). The affordability calculations in the study show that, overall, TACE-DEB can be funded regardless of DRG. A ratio of 1.3 procedures using the conventional (TACE) method would enable TACE-DEB procedures to be funded.ConclusionThis medico-economic analysis demonstrates that the TACE-DEB procedure is fundable.     

Cost-effectiveness model of using zoledronic acid once a year versus current treatment strategies in postmenopausal osteoporosis

ObjectivesTo compare effectiveness, associated cost of outcomes and cost-effectiveness of a single annual infusion of zoledronic acid versus current treatment strategies plans for postmenopausal osteoporosis in France.MethodsTwelve simulation-based models were built to investigate three types of fractures: vertebral (VF), non-vertebral excluding hip (NVF) and hip (HF), comparing two groups: zoledronic acid and current postmenopausal antiosteoporotic treatment strategies. Two effectiveness comparability assumptions have been tested: specific agent efficacy values, and same standard efficacy values for all active agents. Direct medical costs included drug costs, medical visits, monitoring and fracture management. Adherence levels were integrated into the model under the assumption that non-adherent patients had treatment effects similar to the levels of placebo effectiveness.ResultsUsing the most conservative assumption (same standard efficacy values for all active agents), zoledronic acid strategy results in less vertebral, non-vertebral and hip fractures than other current antiosteoporotic treatment options over 3 years: 12.04% vs. 14.18%, 10.61% vs. 11.28% and 2.82% vs. 4.64% respectively, (p < 0.001). In addition, zoledronic acid is more cost-effective than the current treatment strategies in all types of fractures (p < 0.001): 1497 € vs. 1685 € per VF avoided, 1337 € vs. 1404 € per NVF avoided and 1216 € vs. 1323 € per HF avoided.ConclusionZoledronic acid is a cost-effective treatment strategy regardless of fracture type or effectiveness comparability assumptions.     

Denosumab: A cost-effective alternative for older men with osteoporosis from a Swedish payer perspective

ObjectiveTo assess the cost-effectiveness of denosumab versus other treatments in men with osteoporosis who are ≥ 75 years old from a payer perspective in Sweden.MethodsA lifetime cohort Markov model was developed with seven health states: well, hip fracture, vertebral fracture, other osteoporotic fracture, post-hip fracture, post-vertebral fracture, and dead. During each cycle, patients could have a fracture, remain healthy, remain in a post-fracture state or die. Background fracture risks, mortality rates, persistence rates, utilities, medical and drug costs were derived using published sources. Estimates of fracture efficacy were drawn from available studies in post-menopausal osteoporotic (PMO) women as BMD improvements have been shown to be similar across male osteoporosis (MOP) and PMO populations, and a recent clinical trial suggested that the fracture risk reduction from bisphosphonate therapy in men is similar to that seen in women in comparable studies. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, generic risedronate, ibandronate, zoledronate, strontium ranelate and teriparatide. On average, patients in the model were 78 years old, with bone mineral density T-score at the femoral neck of − 2.12. Prevalent vertebral fractures were present in 23% of patients. In the base-case, the model assumed that patients would experience treatment-related effects up to 2 years after discontinuation. Costs and QALYs were discounted at 3% annually. Extensive sensitivity analyses were conducted.ResultsTotal lifetime costs for denosumab, alendronate, strontium ranelate, zoledronate, risedronate, ibandronate and teriparatide were €31,004, €33,731, €34,788, €34,796, €34,826, €35,983 and €37,461, respectively. Total QALYs were 5.23, 5.15, 5.15, 5.17, 5.13, 5.12 and 5.22, respectively. Compared to other treatments, denosumab had the lowest costs and highest QALYs. In the one-way sensitivity analyses, when compared to alendronate (next least expensive strategy), the ICER for denosumab was most sensitive to the relative risk of hip fracture on denosumab. The probability of denosumab being cost-effective compared to the other treatments at a threshold of €66,000/QALY was 96.1%.ConclusionDenosumab dominated all comparators, including generic bisphosphonates, in the treatment of osteoporosis in men who were ≥ 75 years old in Sweden.     

Uso de recursos sanitarios y costes asociados en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva tratados con antimuscarínicos en la práctica médica habitual

ObjectiveTo evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice.Material and methodsA multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age > 75 years, poor/average age for health and difficulty in at least one daily physical activity. Main measures: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs.ResultsRecords of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N = 58), solifenacin (N = 252) or tolterodine (N = 212). The use of absorbent was 20.7%, 29.4% and 33.0% (P = .186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, € 1,775 (1550-2014) vs. solifenacin € 2,062 (1911-2223) and tolterodine € 2,149 (1,978-2,307), P = .042, as a result of lower utilization visits and concomitant medication.ConclusionsDespite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs.     

Extracorporeal life support is safe in trauma patients

IntroductionThe role of extracorporeal life support (ECLS) in the critically ill trauma patient is poorly defined, possibly leading to the underutilization of this lifesaving therapy in this population. This study examined survival rates and risk factors for death in trauma patients who received ECLS.MethodsData from the National Trauma Data Bank was retrospectively reviewed to identify trauma patients who received ECLS from January 2012 to December 2014. Clinical outcomes and risk factors for death were examined in these patients.ResultsEighty patients were identified and included in the final analysis. Overall survival to hospital discharge was 64%. Survivors and non-survivors were similar in regard to age, gender, weight, and injury mechanism. Non-survivors had greater median injury severity scores (ISS) (29 non-survivors vs. 24 survivors, p = 0.018) and had a shorter median total hospital length of stay (8 days non-survivors vs. 32 days survivors, p < 0.001). Analysis of specific anatomic locations of traumatic injury, including serious head/neck, thoracic, and abdominal injuries, revealed no impact on patient survival. Multivariable logistic regression analysis identified increasing age and ISS as significant risk factors for mortality; whereas treatment at facilities that performed multiple ECLS runs over the study period was associated with improved survival.ConclusionsExtracorporeal life support appears to be an effective treatment option in trauma patients with severe cardiopulmonary failure. Survival in trauma patients receiving ECLS is similar to that observed in the general ECLS population and this may represent an underutilized therapy in this population.     

Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial

ObjectivesRheumatoid arthritis (RA) is a prevalent and disabling disease that is the source of significant direct and indirect costs. The current recommended therapeutic strategy is based on the rapid introduction of therapy with conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs) combined with regular disease monitoring by the rheumatologist. The onerous nature of such intense monitoring has motivated the development of new, less demanding strategies such as telemedicine. This study aimed to estimate the cost-effectiveness of the connected monitoring of RA patients initiating a new DMARD therapy versus conventional monitoring.MethodsAn economic evaluation based on a randomized controlled trial of 89 patients was conducted. The patients in the intervention group (n = 45) were monitored using a connected monitoring interface on a smartphone, while patients in the control group (n = 44) were conventionally monitored. Health outcomes were measured as the gain in quality-adjusted life-years (QALYs), assessed using the EuroQol-5D questionnaire. Resource use and health outcomes were collected alongside the trial and at the six-month follow-up using application data and the related clinical case manager time, visits, hospitalisations, and transport records. These outcomes were valued using externally collected data on unit costs and QALY weights.ResultsCompared to conventionally monitored patients, patients receiving connected monitoring had a slightly greater but not significant gain in the average QALY of 0.07. The economic analysis found that connected monitoring resulted in a significant cost reduction of 72€ (2927€ vs. 2999€, P < 0.01). The incremental cost-utility ratio of the intervention was equal to –1,029€ per QALY (95% CI: –32,033; +24,625) with a 97.8% chance of being cost-effective at a threshold of 30,000€ per QALY gained.ConclusionImplementing EULAR recommendations for RA patients initiating a DMARD treatment using connected monitoring is more efficient and less expensive than conventional care.Clinical trial registration numberClinicalTrials.gov (NCT03005925).     

Economic impact of rheumatoid arthritis (RA) biotherapies in France

ObjectiveDetermining the economic impact of rheumatoid arthritis (RA) biotherapies in France.MethodThe number of patients on RA biotherapy in France was estimated from the French national medical information system program (PMSI) database using the 2007 hospital data. The cost of each biotherapy was calculated on a theoretical basis (French national health authority (HAS) recommendations) and on real-life setting, using ‘real-life’ setting data. In order to calculate the economic impact of the biotherapies, the cost of management with each biotherapy was applied to the RA patient population taking into account the market share of each biotherapy.ResultsThe number of patients with RA estimated was 15,873. Management costs ranged from 11,576 to 21,128 € for the theoretical management scenario and from 6,451 to 19,618 € for the real-life scenario. The overall cost was 222 million € (real-life setting). TNF antagonists (adalimumab, etanercept, infliximab) were prescribed for 82% of the patient population and accounted for 80% of the annual overall cost of theoretical management and 84% of the cost of the real-life setting, respectively. Other biotherapies (abatacept, rituximab) were prescribed for 18% of the patients and accounted for 20 and 16% of the annual overall cost of the theoretical setting and real-life setting. Outpatient biotherapy was prescribed for 61% of the patient population and generated 68 and 71% of the total costs.ConclusionThe data constitutes an initial inventory of the economic impact of RA biotherapies in France.     

Does osteopathic manipulative treatment (OMT) improves outcomes in patients who develop postoperative ileus: A retrospective chart review

IntroductionThe treatment of ileus has been estimated to cost the United States $750 million to $1 billion in a year. In a study by Bennett-Guerrero et al. on 1056 patients who had major non-cardiac surgery, the most frequent problem that delayed discharge was persistent postoperative GI tract dysfunction in 42% of patients. Despite its huge cost to our society, there have been very few advances in our approach to treatment of ileus. Upon reviewing osteopathic literature for treatment of postoperative ileus it seemed that OMT may be of benefit to patients being treated for ileus in the hospital setting.Materials and methodsAll patients (n = 655) with a discharge diagnosis of ileus (ICD-9-CM International Code 530.1) between 2003 and 2006 were reviewed. There where 331 patients who had undergone abdominal surgery and were included in the study. Patient records were then divided into two groups, those who had received osteopathic manipulative treatment (OMT) and those who had not received OMT. The data for this study was analyzed using ANCOVA.ResultsAn analysis of covariance (ANCOVA) computed on length of stay by group with age as the covariate indicated that the OMT patients had a significantly shorter length of stay than the no treatment group (adjusted mean = 14.6 days for the non-treatment group versus 11.8 days for the treatment group) even after controlling for age differences; F (1,308) = 4.81, p = 0.029.ConclusionThe findings of this retrospective chart review indicate that a prospective trial including a more thorough economic cost-benefit analysis would be worthy of consideration.     

Budget impact analysis in Spanish patients with Dupuytren's contracture: Fasciectomy vs. collagenase Clostridium histolyticum

The aim of this study was to estimate the budget impact of collagenase Clostridium histolyticum (CCH) vs. fasciectomy (FSC) surgery for the treatment of Dupuytren's disease (DD) in Spain. A cost minimization analysis was adopted (effectiveness was assumed to be equivalent for both techniques). DD related costs were considered. CCH costs (including drug, administration and visits) were obtained from clinical trials and a real-life study. FSC costs (including type of admission, visits, operating room, re-admissions, tests, drugs and rehabilitation costs) were collected through a retrospective, observational, local study. Unit costs were obtained from local database systems (e-SALUD and BOT). Results were presented from the NHS perspective for the next 3 years. We assumed that there were 5100 fasciectomies per year (with a 5% annual increase) and that 20%, 30% and 40% of them will annually utilize CCH. In addition, a 10%, 15% and 20% of untreated diagnosed patients were expected to receive CCH. All the data were validated through an expert panel. A sensitivity analysis was performed with the main variables. The average FSC cost was € 2250 (72% inpatients), € 1703 for outpatients and € 2467 for inpatients. The average CCH cost was € 1220 (1.5 vial/injection and four visits) and could drop to € 898 (1.1 vial/injections and three visits). The accumulated 3 years budget impact analysis (BIA) was 45,971 € (K€ −2993¹; 3870). According to this study, the inclusion of the CCH should produce a 3-year cumulative budgetary impact of € 45,971 (K€ −2993; 3870) for the NHS.     

Socioeconomic impact of ankylosing spondylitis in Tunisia

ObjectiveAnkylosing spondylitis (AS) is the second most common chronic inflammatory joint disease after rheumatoid arthritis and causes substantial functional impairment, two features that generate a heavy socioeconomic burden. Here, our objective was to assess the socioeconomic impact of AS and to identify factors associated with higher costs.Patients and methodsWe retrospectively reviewed the medical charts of 50 patients with AS seen at the Monastir Public Health Service Hospital over the 6-month period from March to September 2006. The following were evaluated: direct costs of medical care; indirect costs related to work incapacity; and impact on marital life, offspring, social activities, and activities of daily living.ResultsThere were 42 men and eight women (male-to-female ratio, 5.25) with a mean age of 38.9 ± 10.8 years (range, 19–60 years). The median mean direct cost of medical care for AS was 426.072 Tunisian Dinars (TND) (266.295 €) per year, and the interquartile range (IQR) was 270.468 TND. Of the 34 patients who had paid employment, 12 (35%) were on sick leave. The mean indirect cost was 447.4 ± 294.3 TND (279.625 ± 183.937 €) per patient per year. The median mean total cost was 873.472 TND (545,92 €) per patient per year with an IQR of 292,324 TND. Factors associated with higher costs were the use of nonsteroidal anti-inflammatory drugs and higher values of the BASDAI and BASRI. Among married patients, 44.4% reported sexual problems, which correlated with the BASMI; and 37% reported a negative reaction on the part of the healthy spouse. Adverse effects on schooling and quality of life of the children were noted in 29.6% of cases. Among single patients, 30.4% felt their disease was responsible for their unmarried status. The disease adversely affected the ability to carry out many activities of daily living (grooming in 38% of cases, housework in 76%, shopping in 92%, sporting activities in 96%, socializing in 68%, and traveling in 80%). The patients usually reported receiving support from their family, which was physical in 74% of cases, financial in 52%, and psychological in 90%.ConclusionOur data indicate that AS generates a major socioeconomic burden. Most of the factors associated with higher costs were related to greater disease activity. Therefore, early appropriate treatment is crucial. Despite the many socioeconomic problems generated by AS, the patients remained connected to their social network thanks to support from their family and friends.     

Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures,hospital admission patterns as well as length of stay

BackgroundReconstructive surgery remains the main approach to address burn scar contractures. Ablative fractional resurfacing is an increasingly popular tool for severe burn scar management, but its effect on overall burns reconstructive case-mix, operating time and patterns of hospital admission have not been reported.MethodsRetrospective analysis of hospital administrative data from September 2013 to June 2017 was performed evaluating these effects of ablative fractional CO₂ laser (CO₂-AFL).ResultsThe total number of acute burn patients treated at CRGH increased substantially over this timeframe, resulting in 412 elective procedures including 82 before and 330 after introducing CO₂-AFL. The proportion of traditional non-laser reconstructive procedures dropped considerably to 23.9% in about 2.5 years following CO₂-AFL introduction. This change in approach had a profound effect on LOS with average LOS being 1.96 days for non-laser and 0.36 days for CO₂-AFL-procedures (p < 0.001). Anaesthetic times also decreased significantly, with median durations at 90 min pre-laser and 64 min post-laser introduction (p < 0.001), and median anaesthetic times at 87 min (non-AFL) and 57 min (AFL procedures) (p < 0.001).ConclusionAFL profoundly affects elective reconstructive burn case mix with a replacement of conventional reconstructive operations in favour of AFL-procedures. This results in reductions of average LOS and anaesthetic times. Consequently, increased use of AFL in burn scar management could potentially reduce overall costs associated with burn scar reconstruction.     

Effect of Postoperative Restrictive Fluid Therapy in the Recovery of Patients with Abdominal Vascular Surgery

ObjectiveTo compare the outcome of the postoperative administration of a restricted or standard intravenous fluid regimen in patients who underwent elective abdominal vascular surgery. The primary end point was postoperative hospital stay.DesignProspective observer-blinded, randomised controlled trial.Material and methodsPatients were considered eligible if they underwent transperitoneal aorto-iliac approach with infrarenal graft repair. During the operation and intensive care unit stay, fluids were prescribed by the anaesthetists who were unaware of the details of the study. In the vascular surgical ward, patients in the standard group (SG) received 2500 ml of fluids per day, whereas patients in the restricted group (RG) received 1500 ml of fluids per day. All the patients were evaluated on an intention-to-treat basis.ResultsForty patients were randomised to the RG (n = 20) or SG (n = 20). No significant differences were observed in the recovery of gastrointestinal function. However, the postoperative hospital stay was shorter in the RG (8 days) than in the SG (12 days) (p = 0.003).ConclusionsThe use of a restrictive postoperative fluid protocol significantly reduces the duration of hospital stay in patients who have undergone major elective abdominal vascular surgery.