VALVULAR PATIENTS

POST OPERATIVE COURSE, SIZE OF THE LEFT ATRIUM CAN PREDICT THE COST EFFECTIVENESS

Abstract

Cost effectiveness in any surgical procedure is a major contributory factor in the
continuation of medical services in developing countries. Limited data is available in assessing
the factors related with the duration of ICU stay and treatment after valvular replacement
surgeries. Objectives: Our aim was to see the correlation of pre operative Left Atrial size of the
patient and duration of post operative stay in ICU. Study Design: Observational Study. Period:
March 2010 to April 2014. Setting: Faisalabad Institute of Cardialogoy, Faisalabad. Method:
A total of 550 consecutive patients with valvular lesions were included in the study. Their Left
Atrial size was measured echocardiographically pre-operatively and their stay /course in the
ICU was monitored. Result: Three categories were identified in regard with the Left Atrial size
and the ICU stay. If LA size is below 60 cm2, the post operative course & stay in ICU is normal
and lasts for about 1-2 days. If LA size is between 60-65 mm2, the post operative course may
be complicated & prolonged by the atrial fibrillation / flutter for which pharmacological cardio
version may be needed and the stay in ICU is prolonged and may last for about 2-3 days. And
if pre-operative LA size is more the 65 mm2 the patient may behave in entirely different way. His
atrial fibrillation persists in spite of electro cardiovertion or pharmacological cardiovertion and
his stay in ICU may last up to 4-5 days and thus the cost of treatment is raised. Conclusions:
LA size can predict the post operative behavior of the patient in ICU and duration of stay and
expected cost of the treatment. Smaller is the size of LA, shorter is the stay in ICU and thus
lesser is the post operative cost & vice versa.