RESUMO
BACKGROUND: In modern operating rooms, clean and unused medical supplies are routinely discarded and can be effectively recovered and redistributed abroad to alleviate the environmental burden of donor hospitals and to generate substantial health benefits at resource-poor recipient institutions. METHODS: We established a recovery and donation program to collect clean and unused supplies for healthcare institutions in developing nations. We analyzed items donated over a 3-year period (September 2010-November 2013) by quantity and weight, and estimated the projected value of the program under potential nationwide participation. To capture the health benefits attributable to the donated supplies at recipient institutions, we partnered with two tertiary-care centers in Guayaquil, Ecuador and conducted a pilot study on the utility of the donated supplies at the recipient institutions (October 2013). We determined the disability-adjusted life years (DALY) averted for all patients undergoing procedures involving donated items and estimated the annual attributable DALY as well as the cost per DALY averted both by supply and by procedure. RESULTS: Approximately, 2 million lbs (907,185 kg) per year of medical supplies are recoverable from large non-rural US academic medical centers. Of these supplies, 19 common categories represent a potential for donation worth US $15 million per year, at a cost-utility of US $2.14 per DALY averted. CONCLUSIONS: Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.
Assuntos
Cooperação Internacional , Salas Cirúrgicas/economia , Saúde Pública , Equipamentos Cirúrgicos/provisão & distribuição , Adulto , Idoso , Instituições de Caridade/estatística & dados numéricos , Análise Custo-Benefício , Países em Desenvolvimento , Pessoas com Deficiência/estatística & dados numéricos , Equador , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Anos de Vida Ajustados por Qualidade de Vida , Equipamentos Cirúrgicos/economiaRESUMO
CONTEXT: A top-down evaluation of the costs of operating rooms (ORs) is not commonly done because it is relevant mostly in a publicly funded system. OBJECTIVE: This study was conducted to determine the costs and utilization of ORs in a public hospital in Trinidad, West Indies, for two one-year periods using a top-down model. DESIGN: Quantitative observational study.Main Outcome Measures: A "cost-block" model suggested for evaluation of intensive care unit costs was adapted to suit ORs. Data were obtained from personal interviews, records, and surveys from the appropriate hospital departments. Adjusted OR utilization times also were recorded for both years. RESULTS: The total annual costs of 4 ORs for the years 2006 and 2009 were approximately US $2.2 and $3.2 million, respectively. Capital expenditure contributed to 70% of the costs, followed by consumables (15%) and medical staff salary (8%). The daily cost of running the ORs was US $6242 in 2006, which rose to $8873 in 2009. The cost of unutilized OR time was approximately US $298,342 in 2006 and was reduced to $198,315 during 2009. CONCLUSION: The adapted cost-block model was useful to evaluate the costs of ORs in a public hospital in Trinidad and can be used from the government's expenditure perspective. Because the cost of running the ORs was high, efficiency must be improved to minimize waste.
Assuntos
Custos Hospitalares/estatística & dados numéricos , Hospitais Públicos/economia , Hospitais de Ensino/economia , Salas Cirúrgicas/economia , Salas Cirúrgicas/estatística & dados numéricos , Humanos , Trinidad e TobagoRESUMO
FUNDAMENTO: Técnicas cirúrgicas de revascularização miocárdica sem o uso de circulação extracorpórea (CEC) projetaram esperanças de resultados operatórios com menor dano sistêmico, menor ocorrência de complicações clínicas e menor tempo de internação hospitalar, gerando expectativas de menor custo hospitalar. OBJETIVO: Avaliar o custo hospitalar em pacientes submetidos à cirurgia de revascularização miocárdica com e sem o uso de CEC, e em portadores de doença multiarterial coronariana estável com função ventricular preservada. MÉTODOS: Os custos hospitalares foram baseados na remuneração governamental vigente. Acrescentaram-se aos custos uso de órteses e próteses, complicações e intercorrências clínicas. Consideraram-se o tempo e os custos de permanência na UTI e de internação hospitalar. RESULTADOS: Entre janeiro de 2002 e agosto de 2006, foram randomizados 131 pacientes para cirurgia com CEC (CCEC) e 128 pacientes sem CEC (SCEC). As características basais foram semelhantes para os dois grupos. Os custos das intercorrências cirúrgicas foram significativamente menores (p < 0,001) para pacientes do grupo SCEC comparados ao grupo CCEC (606,00 ± 525,00 vs. 945,90 ± 440,00), bem como os custos na UTI: 432,20 ± 391,70 vs. 717,70 ± 257,70, respectivamente. Os tempos de permanência na sala cirúrgica foram (4,9 ± 1,1 h vs. 3,9 ± 1,0 h), (p < 0,001) na UTI (48,2 ± 17,2 h vs. 29,2 ± 26,1h) (p < 0,001), com tempo de entubação (9,2 ± 4,5 h vs. 6,4 ± 5,1h) (p < 0,001) para pacientes do grupo com e sem CEC, respectivamente. CONCLUSÃO: Os resultados permitem concluir que a cirurgia de revascularização miocárdica, sem circulação extracorpórea, proporciona diminuição de custos operacionais e de tempo de permanência em cada setor relacionado ao tratamento cirúrgico.
BACKGROUND: Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. METHODS: The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. RESULTS: Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p < 0.001) in patients from the WECC when compared to the SECC group (606.00 ± 525.00 vs. 945.90 ± 440.00), as well as ICU costs: 432.20 ± 391.70 vs. 717.70 ± 257.70, respectively. The duration of the operating room stay were 4.9 ± 1.1 h vs. 3.9 ± 1.0 h, p < 0.001; at the ICU it was 48.2 ± 17.2 h vs. 29.2 ± 26.1h) (p < 0.001), with intubation time of 9.2 ± 4.5 h vs. 6.4 ± 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. CONCLUSION: The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Circulação Extracorpórea/economia , Custos Hospitalares/estatística & dados numéricos , Revascularização Miocárdica/economia , Unidades de Terapia Intensiva/economia , Tempo de Internação/economia , Revascularização Miocárdica/métodos , Salas Cirúrgicas/economia , Complicações Pós-Operatórias/economia , Estatísticas não Paramétricas , Fatores de TempoRESUMO
BACKGROUND: Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. METHODS: The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. RESULTS: Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p < 0.001) in patients from the WECC when compared to the SECC group (606.00 +/- 525.00 vs. 945.90 +/- 440.00), as well as ICU costs: 432.20 +/- 391.70 vs. 717.70 +/- 257.70, respectively. The duration of the operating room stay were 4.9 +/- 1.1 h vs. 3.9 +/- 1.0 h, p < 0.001; at the ICU it was 48.2 +/- 17.2 h vs. 29.2 +/- 26.1h) (p < 0.001), with intubation time of 9.2 +/- 4.5 h vs. 6.4 +/- 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. CONCLUSION: The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment.
Assuntos
Circulação Extracorpórea/economia , Custos Hospitalares/estatística & dados numéricos , Revascularização Miocárdica/economia , Feminino , Humanos , Unidades de Terapia Intensiva/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Salas Cirúrgicas/economia , Complicações Pós-Operatórias/economia , Estatísticas não Paramétricas , Fatores de TempoRESUMO
Trata do problema da imprecisäo nas definiçöes de diária hospitalar e de taxa de sala cirúrgica praticas pelos hospitais no Brasil. Aponta a necessidade de se definir tais termos em razäo de aspectos administrativos, econômicos e jurídicos. Infere a possibilidade de melhoria da competitividade e da eficiência no setor saúde.
Assuntos
Economia Hospitalar , Preços Hospitalares , Hospitais Privados/economia , Administração Hospitalar/economia , Brasil , Custos Hospitalares , Salas Cirúrgicas/economiaRESUMO
OBJECTIVE: To compare laparoscopic and traditional open splenectomy in children with nonmalignant hematologic disorders. STUDY DESIGN: Retrospective review of 36 consecutive nonrandomized splenectomies (16 laparoscopic and 20 open) performed for hematologic disorders at a single pediatric institution during the past 3 years. The two-sided Mann-Whitney U test for non-parametric variables was used for statistical analysis. RESULTS: An open procedure was performed on 20 patients (mean age, 9.7 years), five of whom had a concomitant cholecystectomy. A laparoscopic splenectomy was performed on 16 children (mean age, 10.3 years), seven of whom had a concomitant cholecystectomy. The mean anesthesia and operative times were longer in the laparoscopic than in the open group (p < 0.001). However, the mean number of hours of postoperative analgesia was less in the laparoscopic group (p < 0.005). Patients who had laparoscopic splenectomy were also discharged home earlier (p < 0.01) and resumed a regular diet sooner. Mean operating room charges were higher in the laparoscopic group (p < 0.001), but total hospitalization costs were not significantly different. Postoperative complication rates were similar. The hematologic response was comparable. CONCLUSIONS: laparoscopic splenectomy is feasible and safe in children with hematologic disorders. Although it currently requires more operative time than the open approach, it is superior with regard to duration of postoperative analgesia, duration of hospital stay, and recovery of bowel function.
Assuntos
Doenças Hematológicas/cirurgia , Laparoscopia , Esplenectomia/métodos , Adolescente , Analgesia , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Geral , Criança , Pré-Escolar , Colecistectomia , Colecistectomia Laparoscópica , Dieta , Estudos de Viabilidade , Feminino , Preços Hospitalares , Custos Hospitalares , Hospitalização/economia , Humanos , Intestinos/fisiologia , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Masculino , Salas Cirúrgicas/economia , Tamanho do Órgão , Alta do Paciente , Cuidados Pós-Operatórios , Estudos Retrospectivos , Segurança , Esplenectomia/efeitos adversos , Esplenectomia/economia , Fatores de TempoRESUMO
A traves de un estudio de los recursos quirurgicos que hace parte de una investigacion sistemica, se descubrieron serios problemas de sub-utilizacion de personal y de los recursos fisicos, baja productividad de los cirujanos y baja cobertura respecto a las necesidades de la poblacion. Durante 1974 en el Valle del Cauca se realizaron 50.782 intervenciones quirugicas que recibieron una clasificacion nueva. Tres cuartas partes de ellas eran de baja complejidad y se pudieron haber hecho en forma ambulatoria. El promedio anual de intervenciones fue de 119.7 y 30.6 paraespecialistas y no especialistas, respectivamente. La utilizacion de las 76 salas de cirugia existentes solo fue 41.6%. Se discuten las implicaciones de estos hallazgos