Cath Lab Digest - October 2007 - (Page 62)

CATH LAB COSTS OCTOBER Table 3. Dye and catheters. Means were tested using ANOVA. Amount Radial Femoral 84.1 ±33.9 3.0 ±1.0 Femoral w/Closure 92.7 ± 36.6 3.0 ± 0.5 p-Value 0.61 < 0.001 Dye amount 85.0 ± 46.6 Number of catheters 2.0 ± 1.3 versus 66 ± 10 in Group F and 61 ± 11 in Group F ± C. The majority of patients were white males. There were no significant differences between the three groups in the prevalence of hypertension, diabetes mellitus, congestive heart failure, chronic renal failure, cerebrovascular disease, peripheral vascular disease or previous myocardial infarction, as indicated in Table 1. During the same period, 334 patients were excluded for analysis because they had concurrent procedures such as right heart catheterization, coronary graft cannulation, peripheral angiograms or interventions, or use of intra-aortic balloon pumping. Three patients in the Radial Group had an unsuccessful procedure, and the femoral approach was subsequently adopted. Catheterization results. There were no significant differences in the number of patients with one-vessel, two-vessel, three-vessel or multivessel disease among the three groups, as shown in Table 2. The mean left ventricular ejection fractions, as determined by cardiac catheterization, were also similar. Contrast, catheters and closure devices. As shown in Table 3, while the amount of contrast used was not significantly different between the three groups, more catheters were utilized in both Femoral Groups compared to the Radial Group. Sixteen out of the 70 radial patients had a D-Stat radial band, while 49 closure devices (Angio-Seal or Perclose) were used in 49 patients. Time comparisons. As shown in Table 4, fluoroscopy time was longer in the Radial Group, at 7.4 ± 6.5 minutes, compared to the Femoral Group without closure device use, at 4.5 ± 3.3 minutes (p < 0.01), and was not significantly increased compared to Group F ± C, at 5.9 ± 5.1 minutes. At the same time, procedural duration was nearly identical in all three groups: R = 20.8 ± 12.5 minutes, F = 20.5 ± 9.4 minutes and F ± C = 20.2 ± 11.4 minutes. However, recovery time in the Radial Group, at 126 ± 36 minutes, was nearly half that of the Femoral Group without closure device use, at 240 ± 42 minutes (p < 0.001), and was also significantly shorter than Group F ± C, at 150 ± 48 minutes (p < 0.04). Cost comparisons. Table 5 depicts access cost, catheter cost, contrast cost, closure device cost and recovery cost for all three groups (R, F and F ± C). The results demonstrate the following: • Access cost was significantly higher in the Radial Group, at $93.95, compared with either Femoral Groups, at $40.5 (p < 0.001). • Catheter cost was significantly lower in the Radial Group, at $19.7 ± $12.7, compared with the Femoral Group without closure device use, at $31.1 ± $9.3 and $30.9 ± $9.6 in Group F ± C, (both p < 0.001). • Contrast cost was significantly lower in the Radial Group, at $26.9 ± $17.0, compared with Group F ± C, at $42.9 ± $25.0 (p < 0.001), as well as higher contrast cost in Group F ± C compared with Group F, $32.6 ± $18.9 (p < 0.001). $74.6, compared with the Femoral Group without closure device use, at $446.9 ± $60.2, and Group F ± C, at $553.4 ± $81.0 (both p < 0.001). Procedural complications. No patient in any of the three groups developed a postprocedural complication. It is noteworthy that no patient in the Radial Group developed radial artery spasm or other vascular complications. Discussion Seventeen years after the introduction of the radial artery approach to diagnostic cardiac catheterization by Campeau,1 the femoral approach remains much more commonly used in the United States because it is technically easier and allows the use of larger catheters. However, in Canada and Europe, the radial approach has gained greater acceptance due to more familiarity, while the cardiovascular training programs in the United States have not emphasized the importance of learning this technique.12,13 In experienced hands, the radial approach to diagnostic cardiac catheterization has a number of advantages that need to be emphasized in order to bring greater acceptance of this procedure in The potential of cost savings with the radial approach compared with the femoral (with or without closure device) approach could significantly impact the budget of cardiac catheterization laboratories and recovery units. • Closure device cost was significantly higher in the Radial Group compared with the Femoral Group without closure device use, at $61.4 ± $12.9 versus $36.4 ± $24.9 (p < 0.001), but was significantly lower in than the F ± C Group, at $245.0 ± $0 (p < 0.001). • Recovery cost was significantly lower in the Radial Group compared with the Femoral Group without closure device use, at $185.2 ± $52.7 versus $337.5 ± $59.0 (p < 0.001), and was also lower than the F ± C Group, at $208.0 ± $70.4 (p < 0.05). Total procedural costs including access, catheters, contrast, closure device and recovery costs were significantly lower in the Radial Group, at $369.5 ± the U.S.: (1) The radial artery, unlike the femoral or brachial artery, is not an end-artery. Therefore, even with its possible occlusion, adequate ulnar artery collaterals can salvage the hand from ischemia; (2) the radial artery is more superficial than the femoral artery, therefore it is easily compressible and sheath removal results in diminished risk of bleeding and other vascular complications. A meta-analysis by Agostoni et al5 of 3,244 patients who underwent radial or femoral artery catheterization showed that the former had less entry site complications (0.3% versus 2.8%; p < 0.0001) with similar MACE of 2.2% and 2.4%, respectively; (3) the radial approach carries less risk of nerve injury since there is no adjacent nerve; (4) the radial approach overcomes the limitations and risks of the femoral approach in aorto-iliac vascular disease8 and obese patients; (5) the radial approach allows for reduced postprocedural recovery time, earlier ambulation and earlier discharge, resulting in higher patient satisfaction scores as demonstrated by a number of randomized and nonrandomized clinical trials.3,4 Cooper et al3 showed in a randomized clinical trial comparing 101 patients who underwent the radial technique to 99 patients who underwent the femoral technique, that measures of bodily pain, back pain and walking ability 1 day and 1 week after the procedure both favored the radial approach, which was associated with a mean reduction of length of stay of 6.8 hours. Accordingly, there was a strong patient preference for the radial approach (p < 0.0001). The radial approach has been shown to be more cost effective in general compared to the femoral approach in patients who do not receive femoral closure devices. Amoroso et al10 found in a prospective, nonrandomized comparison between radial and femoral artery catheterization, that the former was an independent predictor of reduced catheterization laboratory nurse workload, but none of those patients received a closure device. Cooper et al3 showed in a randomized trial of radial versus femoral artery catheterization that the former was associated with a shorter hospital stay (3.6 versus 10.4 hours) and reduced hospital costs ($2,010 versus $2,299) in patients who did not have a femoral closure device. Consequently, this study was conducted to compare the cost effectiveness of the radial artery approach to the femoral approach, with or without the utilization of vascular closure devices, in consecutive patients undergoing diagnostic cardiac catheterization without concurrent procedures between October 2004 and May 2006. There were 70 patients in the Radial Group, 62 patients in the Femoral Group without closure device use and 49 patients in the F ± C Group. Patients were excluded due to concurrent procedures. The majority of our patients were white males with a mean age of 63.0 ± 9.0 years, slightly younger than the Femoral Group, at 66.0 ± 10.0 years. No patient developed periprocedural complications. While the fluoroscopy time was longer in the Radial Group due to the more demanding nature of the procedure, the overall procedural time was not significantly different between the three groups. Recovery time was clearly lower in the Radial Group compared with the

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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