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European Heart Journal 1992 13(1):9-14;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Is repeated coronary surgery for recurrent angina cost effective?

D. DOUGENIS, S. NAIK and A. HEDLEY BROWN

Regional Cardiothoracic Centre, Freeman Hospital Newcastle upon Tyne, NE7 7DN, U.K.

Received 8 November 1990; revised 11 February 1991; .

Correspondence: DT D. Dougenis, Department of Surgery, Division of Cardiothoracic Surgery, Patras University Medical School, Patras, Greece

Abstract

Between January 1980 and May 1988, 1363 patients underwent first time coronary artery bypass grafting (CABG) and 49 (3.6%) were reoperated for recurrent angina by the same surgeon in this unit. There were 42 males and five females with a mean age of 53.6 years. Mean time since first operation was 68.9 (37 SD) months. Prior to surgery only eight (16.3%) were still working. There were three hospital deaths and two late deaths at 2.5 and 3.5 years after surgery and one patient underwent cardiac transplantation at 1.5 years. Follow-up has been completed up to March 1989, mean 3.7 years, range 10–108 months.

Questionnaires were sent to all patients concerning the financial and functional situation. Hospital expenses were calculated (a) prospectively for 15 consecutive first time CABGs and for five second time CABGs, (b) retrospectively from patients' records with the help of a simple computer programme. The final figures were corrected for inflation rates. The 1- and5-year actuarial probability of angina-free interval was 87.5% and 40% respectively. Eight patients (12.2%) had no benefit, six (13.6.) had benefit but were not able to work, 16 (36.4%) were able to work but unemployed and 14 (13.8%) were fully employed producing a total salary of £69 072 per annum. Hospital expenses were. first time CABG £3645–£4049, second time CABG £6290–£7235. The total for the entire group was £308 166. Repeated coronary surgery can be accomplished with reasonable mortality and has good late results. However financially, in our region it is not as cost effective, being 1.8 times more expensive and half as good as a first operation at restoring patients to work.

Key Words: Angina • aortocoronary bypass grafting • recurrent angina • re-operation • rehabilitation


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