Jonathan M. Tan

Cost-effectiveness of external cephalic version for term breech presentation

BackgroundExternal cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from societys perspective, of ECV compared to scheduled cesarean for term breech presentation.MethodsA computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g.,

The current status of simulation in the maintenance of certification in anesthesia.

8,023 for cesarean and

CT Guided Percutaneous Cryoneurolysis for Post Thoracotomy Pain Syndrome

5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of

A Cost Analysis of Neuraxial Anesthesia to Facilitate External Cephalic Version for Breech Fetal Presentation

50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness.ResultsThe incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled

Lipid rescue for bupivacaine toxicity during cardiovascular procedures

7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than

A case of intra-operative ventricular fibrillation: Electro-cauterization, undiagnosed Takotsubo cardiomyopathy or long QT syndrome?

50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean.ConclusionsFrom societys perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.

How to Evaluate Whether a New Technology in the Operating Room is Cost-Effective from Society's Viewpoint

Over the past 20 years, simulation in anesthesia education and training has grown significantly. There are currently approximately 60 to 70 anesthesia simulation centers in the United States that are actively being used for training anesthesia residents, medical students, and for continuing medical education activities. Although simulation training for the next generation of anesthesiologists proves to be an expensive, time-consuming, and labor-intensive endeavor, simulation is here to stay. Anesthesia simulation has now achieved enough status that it will be formally incorporated into the Maintenance of Certification in Anesthesia (MOCA). Owing to the growing importance, simulation will now play with all current and future anesthesiologists it is important for all to understand 3 major points regarding simulation: (1) Where did simulation come from that it now plays a role in MOCA?; (2) Why is simulation included in MOCA? (3) Where will simulation go now that it is a part of MOCA? Using the next few pages we will address these important questions through a historic look at simulation in anesthesia, the progression of policy changes leading to simulation being incorporated into MOCA, and compare the state of anesthesia simulation with how our surgical

A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems

RATIONALE AND OBJECTIVES The aim of this study was to determine the effect of cryoablation on pain levels in patients with histories of post-thoracotomy pain syndrome. MATERIALS AND METHODS Eighteen patients were included in this retrospective review. Preprocedural and immediate postprocedural pain scores were recorded, as well as several months after the procedures. RESULTS The average preprocedural pain score was 7.5 +/- 2.0, which decreased to 1.2 +/- 1.9 immediately after the procedure. After a mean follow-up period of 51 days, the average pain score was 4.1 +/- 1.7. The difference between preprocedural and postprocedural pain scores was statistically significant by Wilcoxons rank sum test. CONCLUSION Cryoneurolysis of the intercostal nerves statistically significantly decreased pain scores in patients with post-thoracotomy pain syndrome.

Mortality and Morbidity after Laparoscopic Surgery in Children with and without Congenital Heart Disease

BACKGROUND:In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. METHODS:Using a computer cost model, which considers possible outcomes and probability uncertainties at the same time, we estimated total expected delivery costs for breech presentation managed by a trial of ECV with and without neuraxial anesthesia. RESULTS:From published studies, the average probability of successful ECV with neuraxial anesthesia was 60% (with individual studies ranging from 44% to 87%) compared with 38% (with individual studies ranging from 31% to 58%) without neuraxial anesthesia. The mean expected total delivery costs, including the cost of attempting/performing ECV with anesthesia, equaled

Caudal analgesia and cardiothoracic surgery: a look at postoperative pain scores in a pediatric population

8931 (2.5th–97.5th percentile prediction interval