P3274Surgical ablation of atrial fibrillation evaluation (SAFE): a cost analysis
Bibliographic record
Abstract
Background: International guidelines currently recommend concomitant surgical ablation of atrial fibrillation (AF) in patients with known AF undergoing cardiac surgery. However, recent meta-analyses of randomized controlled trials (RCTs) show no significant difference in clinically meaningful outcomes including mortality and stroke in patients who undergo surgical ablation of AF compared to those who do not. Surgically forced maintenance of sinus rhythm, of dubious clinical relevance, is the only observable benefit; and is not achieved in all patients. Based on LAAOS II data, 10 percent of patients undergoing cardiac surgery have a history of AF. Purpose: Given the absence of clear clinical benefit, we aimed to assess the incremental costs associated with current practice patterns of surgical ablation of AF. Methods: We describe the additional cost incurred at hospital discharge by performing surgical AF ablation per 1000 cardiac surgeries in patients with known AF. To estimate clinical outcomes, we used results from a recent systematic review of 23 RCTs which demonstrated no difference in mortality or stroke with surgical AF ablation, but an increase in hospital length of stay (LOS) of 1.67 days. We used data from the ongoing LAAOS III trial to assess the proportion of cardiac surgery patients with AF who undergo concomitant AF ablation (33%) and the breakdown of technique used (69% radiofrequency, 19% cryoablation, 10% cut-and-sew). Incremental costs incurred included the ablation device costs, professional fees, increase in LOS, and increased requirement for pacemaker implantation. Institutional costs were based on average costs for large academic centers in Ontario, professional fees based on Ontario fee schedule and device costs based on Canadian industry data.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.012 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".