Preoperative spirometry and laparotomy: blowing away dollars.

Abstract:

STUDY OBJECTIVE:Increasing evidence indicates that routine preoperative diagnostic spirometry (pulmonary function tests [PFTs]) before elective abdominal surgery does not predict individual risk of postoperative pulmonary complications and is overutilized. This economic evaluation estimates potential savings from reduced use of preoperative PFTs. DESIGN:Analyses of (1) real costs (resource consumption to perform tests) and (2) reimbursements (expenditures for charges) by third-party payers. SETTING:University-affiliated public and Veterans Affairs hospitals. PATIENTS:Adults undergoing elective abdominal operations. MEASUREMENTS AND RESULTS:Average real cost of PFTs was $19.07 (95% confidence interval [CI], $18.53 to $19.61), based on a time and motion study. Average reimbursement expenditure by third-party payers for PFTs was $85 (range, $33 to $150; 95% CI, $68 to $103), based on Medicare payment of $52 and a survey of nine urban US hospitals with a spectrum of bed sizes and teaching status. Estimates from published literature included the following: (1) annual number of major abdominal operations, 3.5 million; and (2) proportion of PFTs not meeting current guidelines, 39% (95% CI, 0.31 to 0.47). Local data were used when estimates were not available in the literature: (1) proportion of laparotomies that are elective, 76% (95% CI, 0.73 to 0.79); and (2) frequency of PFTs before laparotomy, 69% (95% CI, 0.54 to 0.84). Estimated annual national real costs for preoperative PFTs are $25 million to $45 million. If use of PFTs were reduced by our estimate for the proportion of PFTs not meeting current guidelines, potential annual national cost savings would be $7,925,411 to $21,406,707. National reimbursement expenditures by third-party payers range from more than $90 million to more than $235 million. If use were reduced, potential annual savings in reimbursements would be $29,084,076 to $111,345,440. Potential savings to Medicare approach $8 million to $20 million annually. CONCLUSION:Reduced use of PFTs before elective abdominal surgery could generate substantial savings. Current evidence indicates reduced use would not compromise patients' outcomes.

journal_name

Chest

journal_title

Chest

authors

De Nino LA,Lawrence VA,Averyt EC,Hilsenbeck SG,Dhanda R,Page CP

doi

10.1378/chest.111.6.1536

subject

Has Abstract

pub_date

1997-06-01 00:00:00

pages

1536-41

issue

6

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)47038-2

journal_volume

111

pub_type

杂志文章

相关文献

CHEST文献大全
  • Establishment and characterization of 20 human non-small cell lung cancer cell lines in a serum-free defined medium (ACL-4).

    abstract::To facilitate the studies in cell biology and drug sensitivity of non-small cell lung cancer, cell samples from 55 patients have been used to establish cell lines in culture using a chemically defined medium (ACL-4). A total of 20 cell lines (36 percent) were directly established and characterized: 14 (44 percent) fro...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.100.2.429

    authors: Masuda N,Fukuoka M,Takada M,Kudoh S,Kusunoki Y

    更新日期:1991-08-01 00:00:00

  • Self-injection with olive oil. A cause of lipoid pneumonia.

    abstract::A 48-year-old man with unipolar depression and a psychosexual problem concerning his body image was injecting his scrotum repeatedly with olive oil to increase the size of his genitals. He developed respiratory failure following accidental intravenous injection of olive oil and was found to have lipogranulomatous lesi...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.107.3.875

    authors: Bhagat R,Holmes IH,Kulaga A,Murphy F,Cockcroft DW

    更新日期:1995-03-01 00:00:00

  • Delayed post-myocardial infarction invasive measures, helpful or harmful? A subgroup analysis.

    abstract:BACKGROUND:In patients who have experienced acute myocardial infarction (MI), primary percutaneous coronary intervention (PCI) has been shown to be of benefit in terms of clinical outcomes. However, the value of performing routine PCI in patients with early MI (ie, an MI occurring > 12 h to < or = 7 days before patient...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.126.1.38

    authors: Yip HK,Wu CJ,Yang CH,Chang HW,Chen SM,Hung WC,Hang CL

    更新日期:2004-07-01 00:00:00

  • Comorbid conditions and outcomes in patients with pulmonary arterial hypertension: a REVEAL registry analysis.

    abstract:BACKGROUND:Comorbidities can affect disease progression and/or response to treatment in various conditions. Comorbid conditions are prevalent in patients with pulmonary arterial hypertension (PAH); however, their effect on patient outcomes remains unknown. METHODS:We evaluated the effect on functional class (FC), 6-mi...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.11-3241

    authors: Poms AD,Turner M,Farber HW,Meltzer LA,McGoon MD

    更新日期:2013-07-01 00:00:00

  • Radiographic pseudofracture of bipolar pacemaker wire.

    abstract::We present a case in which the radiographic appearance of a bipolar pacing lead mimics a wire fracture. Recognition of this normal finding--due to lead construction--will help avoid erroneous diagnosis of wire fracture on chest x-ray films. ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.88.2.302

    authors: Hecht S,Berdoff R,Van Tosh A,Goldberg E

    更新日期:1985-08-01 00:00:00

  • Clinical relevance of the interaction of theophylline with diltiazem or nifedipine.

    abstract::The results of previously published studies indicate that calcium channel blockers are capable of competitively inhibiting cytochrome P-450 activity in hepatic microsomes, the pathway of theophylline metabolism. In addition, case reports have suggested that theophylline serum concentrations change when a calcium chann...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.95.2.309

    authors: Christopher MA,Harman E,Hendeles L

    更新日期:1989-02-01 00:00:00

  • Bronchoalveolar lavage-induced pneumothorax.

    abstract::Bronchoalveolar lavage (BAL) has not been associated with the complication of pneumothorax. Candidates for this procedure are predisposed to develop pneumothorax due to underlying infectious interstitial emphysema. This risk factor is increased by the hyperbaric consequences of lavage and also by the cough induced by ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.94.2.440

    authors: Krueger JJ,Sayre VA,Karetzky MS

    更新日期:1988-08-01 00:00:00

  • Effects of theophylline on breathlessness and exercise tolerance in patients with chronic airflow obstruction.

    abstract::Theophylline is commonly prescribed for patients with nonasthmatic chronic airflow obstruction (CAO) even though clinical efficacy is not well established. We studied objective and subjective responses to theophylline in 14 men with CAO. Subjects randomly received week-long treatments of placebo or theophylline at two...

    journal_title:Chest

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1378/chest.82.5.538

    authors: Eaton ML,MacDonald FM,Church TR,Niewoehner DE

    更新日期:1982-11-01 00:00:00

  • Occupational risk factors for sarcoidosis in African-American siblings.

    abstract:OBJECTIVES:To determine whether certain occupations and occupationally related exposures were associated with a history of sarcoidosis in African-American siblings. METHODS:We collected occupational data from 921 African Americans in 273 sibships that had been identified through a sarcoidosis case. Among the 648 sibli...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.123.5.1527

    authors: Kucera GP,Rybicki BA,Kirkey KL,Coon SW,Major ML,Maliarik MJ,Iannuzzi MC

    更新日期:2003-05-01 00:00:00

  • Dyspnea in a patient years after severe poliomyelitis. The role of cardiopulmonary exercise testing.

    abstract::Dyspnea after polio can occur for a variety of reasons, including neuromuscular disease and upper airway abnormalities resulting from prolonged intubation, including tracheal stenosis, tracheomalacia, and vocal cord paralysis. Routine studies such as spirometry and maximum voluntary ventilation (MVV) measurements can ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.105.3.777

    authors: Knobil K,Becker FS,Harper P,Graf LB,Wolf GT,Martinez FJ

    更新日期:1994-03-01 00:00:00

  • Airway hyperreactivity in cystic fibrosis. Clinical correlates and possible effects on the course of the disease.

    abstract::To evaluate whether increased airway reactivity affected the course of patients with cystic fibrosis (CF), we categorized 40 CF patients as to methacholine sensitivity and then evaluated their disease activity and natural history. Twenty methacholine reactors had more severe lung disease (lower S-K clinical scores and...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.94.2.360

    authors: Eggleston PA,Rosenstein BJ,Stackhouse CM,Alexander MF

    更新日期:1988-08-01 00:00:00

  • Abnormal lung gallium-67 uptake preceding pulmonary physiologic impairment in an asymptomatic patient with Pneumocystis carinii pneumonia.

    abstract::Pneumocystis carinii pneumonia was suggested by a diffuse, bilateral pulmonary uptake of gallium-67 in an asymptomatic, homosexual male with the antibody to the immunodeficiency virus (HIV) who was undergoing staging evaluation for lymphoma clinically localized to a left inguinal lymph node. Chest radiograph and pulmo...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.97.5.1261

    authors: Reiss TF,Golden J

    更新日期:1990-05-01 00:00:00

  • Quality of life and inflammatory markers in mild asthma.

    abstract:STUDY OBJECTIVES:The aim of this study was to explore the relationship between quality of life and measures of asthma, such as lung function, reversibility to bronchodilation, exhaled nitric oxide (NO), and bronchial responsiveness to direct and indirect stimulus in patients with mild asthma in a primary care setting. ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.129.3.624

    authors: Ehrs PO,Sundblad BM,Larsson K

    更新日期:2006-03-01 00:00:00

  • Pulmonary Langerhans cell histiocytosis-associated pulmonary hypertension: clinical characteristics and impact of pulmonary arterial hypertension therapies.

    abstract:BACKGROUND:Precapillary pulmonary hypertension (PH) is a complication of pulmonary Langerhans cell histiocytosis (PLCH) associated with increased mortality. However, outcomes and efficacy of pulmonary arterial hypertension (PAH) therapies in patients with PH complicating PLCH(PLCH-PH) remain unknown. METHODS:Consecuti...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.11-2490

    authors: Le Pavec J,Lorillon G,Jaïs X,Tcherakian C,Feuillet S,Dorfmüller P,Simonneau G,Humbert M,Tazi A

    更新日期:2012-11-01 00:00:00

  • Human Epididymis Protein 4: A Novel Serum Inflammatory Biomarker in Cystic Fibrosis.

    abstract:BACKGROUND:Increased expression of the human epididymis protein 4 (HE4) was previously described in lung biopsy samples from patients with cystic fibrosis (CF). It remains unknown, however, whether serum HE4 concentrations are elevated in CF. METHODS:Seventy-seven children with CF from six Hungarian CF centers and 57 ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1016/j.chest.2016.04.006

    authors: Nagy B Jr,Nagy B,Fila L,Clarke LA,Gönczy F,Bede O,Nagy D,Újhelyi R,Szabó Á,Anghelyi A,Major M,Bene Z,Fejes Z,Antal-Szalmás P,Bhattoa HP,Balla G,Kappelmayer J,Amaral MD,Macek M Jr,Balogh I

    更新日期:2016-09-01 00:00:00

  • Eosinophil activation in patients with pulmonary fibrosis.

    abstract::The eosinophil count and concentrations of eosinophil cationic protein (ECP) were measured in bronchoalveolar lavage fluid (BALF) from patients with idiopathic pulmonary fibrosis (IPF), pulmonary fibrosis associated with a collagen vascular disorder (PF-CVD), sarcoidosis, and healthy controls. The patients with IPF an...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.108.1.48

    authors: Fujimoto K,Kubo K,Yamaguchi S,Honda T,Matsuzawa Y

    更新日期:1995-07-01 00:00:00

  • An analysis of in vitro T cell responsiveness in nontuberculous mycobacterial infection.

    abstract::In vitro cell-mediated immunity was examined in patients infected with nontuberculous mycobacteria, Mycobacterium avium-intracellulare complex in Japan. Peripheral blood lymphocytes of patients, as compared with those of tuberculous patients or tuberculin-positive healthy donors, showed depressed in vitro blastogenic ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.94.4.822

    authors: Tsuyuguchi I,Shiratsuchi H,Okuda Y,Yamamoto Y

    更新日期:1988-10-01 00:00:00

  • Measurements of cardiac output in seriously ill patients using a CO2 rebreathing method.

    abstract::A CO2 rebreathing method for the measurement of cardiac output was evaluated by comparison with the direct Fick O2 method in 26 studies performed in 18 patients who were critically ill. The method requires measurement of CO2 output by collection of expired gas, of arterial PCO2, and of mixed venous PCO2 by rebreathing...

    journal_title:Chest

    pub_type: 临床试验,杂志文章

    doi:10.1378/chest.73.2.167

    authors: Davis CC,Jones NL,Sealey BJ

    更新日期:1978-02-01 00:00:00

  • Environmental tobacco smoke may induce early lung damage in healthy male adolescents.

    abstract:STUDY OBJECTIVE:Childhood exposure to environmental tobacco smoke (ETS) adversely affects dynamic spirometric indexes as a result of combined early life (including in utero) and current exposure to parental smoking. The aim of our study was to investigate the effect of ETS on lung function and to identify the most sens...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.125.4.1387

    authors: Rizzi M,Sergi M,Andreoli A,Pecis M,Bruschi C,Fanfulla F

    更新日期:2004-04-01 00:00:00

  • Nuclear accumulation of p53 is a potential marker for the development of squamous cell lung cancer in smokers.

    abstract:STUDY OBJECTIVES:To determine whether the nuclear accumulation of p53 in patients with early bronchial neoplasia represents an altered susceptibility for the development of lung cancer. PATIENTS AND MEASUREMENTS:We evaluated the percentage of cells accumulating nuclear p53 immunohistochemically in squamous cell carcin...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.123.1.181

    authors: Piyathilake CJ,Frost AR,Manne U,Weiss H,Heimburger DC,Grizzle WE

    更新日期:2003-01-01 00:00:00

  • Diagnostic accuracy of coronary angiography utilizing computer-based digital subtraction methods. Comparison to conventional cineangiography.

    abstract::To evaluate the efficacy of mask-mode digital subtraction angiography in selective coronary arteriography, we compared computer-based digital subtraction angiograms to standard film-based angiograms in 77 patients. Digital angiography was performed utilizing a 512(2) matrix and a framing rate of 30 frames/second. Radi...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.90.6.793

    authors: Goldberg HL,Moses JW,Fisher J,Tamari I,Borer JS

    更新日期:1986-12-01 00:00:00

  • Torsades de pointes induced by erythromycin.

    abstract::We describe two patients who develop torsades de pointes in a temporal relationship to the intravenous administration of erythromycin lactobionate in the absence of other drugs or metabolic abnormalities known to cause the arrhythmia. We also review the current literature regarding this topic, including other case his...

    journal_title:Chest

    pub_type: 杂志文章,评审

    doi:10.1378/chest.105.2.368

    authors: Gitler B,Berger LS,Buffa SD

    更新日期:1994-02-01 00:00:00

  • Minimal effect of alcohol ingestion on breathing during the sleep of postmenopausal women.

    abstract::Eighteen asymptomatic postmenopausal women volunteered to ingest 2 ml of 100-proof vodka per kg of body weight in orange juice on one night and a placebo on another. Overnight sleep monitoring was performed immediately thereafter. Alcohol ingestion caused reduction in total sleep time from 329 to 281 minutes and a dec...

    journal_title:Chest

    pub_type: 临床试验,杂志文章

    doi:10.1378/chest.88.2.181

    authors: Block AJ,Hellard DW,Slayton PC

    更新日期:1985-08-01 00:00:00

  • Exercise-associated cardiac asystole in persons without structural heart disease.

    abstract::Exercise-associated cardiac asystole (EACA) in patients without structural heart disease is uncommonly encountered. Two patients who developed prolonged asystolic arrest associated with exercise are described; both demonstrated a positive head-up tilt table response, absence of underlying heart disease, and a history ...

    journal_title:Chest

    pub_type: 杂志文章,评审

    doi:10.1378/chest.107.2.572

    authors: Tse HF,Lau CP

    更新日期:1995-02-01 00:00:00

  • Further observations on the electrophysiologic effects of oral amiodarone therapy.

    abstract::A case is presented of a reversible intra-Hisian block occurring under amiodarone treatment for atrial tachycardia in a patient without clear intraventricular conduction abnormalities. His bundle recordings showed an atrial tachycardia with intermittent exit block and greatly prolonged BH and HV intervals (40 and 100 ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.82.1.117

    authors: Santinelli V,Chiariello M,Ambrosio G,Stanislao M,Condorelli M

    更新日期:1982-07-01 00:00:00

  • Frequency of pleural effusions in patients with pulmonary arterial hypertension associated with connective tissue diseases.

    abstract:BACKGROUND:Pleural effusions frequently accumulate in patients with left-sided heart failure. However, our recent study in patients with idiopathic and heritable pulmonary arterial hypertension (PAH) demonstrated that pleural effusions frequently occur in patients with isolated right-sided heart failure (RHF). The obje...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.10-0227

    authors: Luo YF,Robbins IM,Karatas M,Brixey AG,Rice TW,Light RW

    更新日期:2011-07-01 00:00:00

  • Compensation for byssinosis in Great Britain.

    abstract::Byssinosis first became compensatable in Great Britain in May 1941. The claimants were examined by a specially constituted board consisting of chest physicians and medical specialists from the Manchester area. Following the Industrial Injuries Act of 1946, which became operative in July 1948, the examinations were tak...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.79.4_supplement.124s

    authors: Rooke GB

    更新日期:1981-04-01 00:00:00

  • Prevalence rates of asthma in developing countries and their comparison with those in Europe and North America.

    abstract::Prevalence rates for asthma in various parts of the world are different and this cannot be entirely explained by differences in methodology. Low prevalence rates are found in third world countries, particularly marked for children. The reasons for these differences are obscure but are largely environmental. Some sugge...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.91.6_supplement.97s

    authors: Cookson JB

    更新日期:1987-06-01 00:00:00

  • Trends in mechanical ventilation among patients hospitalized with acute exacerbations of COPD in the United States, 2001 to 2011.

    abstract:BACKGROUND:The use of noninvasive ventilation (NIV) in acute exacerbation of COPD has increased over time. However, little is known about patient factors influencing its use in routine clinical practice. METHODS:This was a retrospective cohort study of 723,560 hospitalizations for exacerbation of COPD at 475 hospitals...

    journal_title:Chest

    pub_type: 杂志文章,多中心研究

    doi:10.1378/chest.14-1216

    authors: Stefan MS,Shieh MS,Pekow PS,Hill N,Rothberg MB,Lindenauer PK

    更新日期:2015-04-01 00:00:00

  • Color Doppler features of left ventricular pseudoaneurysm.

    abstract::A patient had left ventricular pseudoaneurysm after mitral valve replacement surgery. The diagnosis was made by color flow Doppler demonstration of systolic flow between the left ventricular chamber and an echo-free space posterior to the heart which was initially interpreted as localized pleural effusion. Color Doppl...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.95.1.231

    authors: Alam M,Rosman HS,Lewis JW,Brymer JF

    更新日期:1989-01-01 00:00:00