Employability--a new indication for aneurysmectomy and coronary revascularization

Increasing governmental concern with containment of medical costs prompted us to evaluate the efficacy and cost effectiveness of ventricular aneurysmectomy and coronary revascularization. Sixty-six patients underwent ventricular aneurysmectomy between August 1973 and June 1978. Their classification according to the New York Heart Association criteria, their employment status (fully employed, working part time or totally disabled) and their salaries and disability payments for the 11-month periods before and after surgery were compared. There were five hospital deaths (7.6%) with a 40-month actuarial survival of 74%. Ninety-five percent percent of the survivors were class I or class II 20 months (average) postoperatively, full employment increased form 33% preoperatively to 63% postoperatively and total disability decreased from 60% preoperatively to 29% postoperatively. The efficacy of surgery in this group of patients in terms of financial implact on the community was analysed: the cost of surgery averaged $10,537.00 per patient. Computing the income actually earned by the entire group of patients, the disability payments to the individual patients and the lost tax revenues through disability shows that the cost of surgery for the whole group could be paid by 1.68 years of improved postoperative productivity.