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Coronavirus disease 19 (COVID-19) first emerged in December 2019 in China and rapidly spread worldwide. While various studies have reported that COVID-19 is associated with a hypercoagulable state and thrombotic complications in critically ill patients, there are scant case reports on thrombotic events as one of the presenting symptoms. We report a case of acute upper extremity ischemia as the initial clinical presentation of a COVID-19 patient.
disposable supply cost, supply cost alone, and cost per time. Cost was analyzed over two periods: the 24 months prior (PRE) to the tool implementation and 24 months following (POST) with a 1-month washout. Medians and interquartile ranges were calculated for each parameter and compared using the Mann-Whitney U test.Results: We analyzed a total of 1372 procedures performed over the time period studied. Total supply and implant cost (e17.5%; P ¼ .008), supply cost (e1.99%; P ¼ .049) and cost per minute (e28.24%; P ¼ .015) all saw significant reductions across the composite of open procedures from the PRE to POST time point (Table ). Largest supply cost reductions were seen in common femoral artery endarterectomy (e42%; P < .001). The total operative cost/time was most significantly reduced for carotid endarterectomy (e8.89%; P ¼ .001), abdominal aortic aneurysm repair (e16.21; P ¼ .019), carotid-subclavian bypass (e9.94%; P ¼ .032), and common femoral endarterectomy (e41.16%; P ¼ .06), with nonsignificant cost reductions in arteriovenous grafting and rib resection. Relative price increases of 31%, 8%, and 3% were calculated for temporal artery biopsy, vein transposition, and distal bypass, respectively. The composite of all endovascular procedures saw large implant cost increases with minimal change in supply cost.Conclusions: We demonstrate that a low-cost, highly implemenTable cost sheet is effective at reducing cost in vascular surgery. Further investigations should assess how and why surgeons choose supplies and implants in order to target further intraoperative cost savings.
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