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Home > Vascular Annual Meeting > PVSS5. Hospital Cost and Clinical Outcomes Following...

PVSS5. Hospital Cost and Clinical Outcomes Following Open and Endovascular Thoracic Aortic Repair

Girma Tefera, MD; John Hoch, MD; Matthew Mell, MD; William Turnipseed, MD; Charles Acher, MD
University of Wisconsin Med.School, Madison, WI

OBJECTIVES: The benefit of endovascular therapy of thoracic aortic pathologies has widely been reported however, the cost associated with these procedures is not well documented. The objective of this study was to perform in hospital cost and clinical outcome comparisons in patients who underwent Endovascular repair (TEVAR) to open thoracic aneurysm repair (Open).

METHODS: This is a retrospective study in a tertiary care center. TAG device was used in all TEVAR cases and comparison was made with patients treated with open technique. Demographics, procedure related morbidity and mortality, length of hospital stay as well as hospital costs were recorded. Cost was divided in total hospital cost, direct cost, operating room total cost and nursing total cost. The net margin was calculated by subtracting revenue from total hospital cost. Comparisons between Open and TEVAR were analyzed using a non parametric version of two sample t test, Wilcoxon rank sum test. All p-values reported are two-sided; p<0.05 was the criterion for statistical significance. Statistical computations were performed in SAS for Windows version 9.1.3 (SAS Institute; Cary, NC, USA).

RESULTS: During a 20 month period, November 2006 to May 2008, sixty patients were identified. Of these 25 patients were in the TEVAR group and 35 in the Open group. In average, 1.8 stent grafts per patient was used (range 1-3). Morbidity and Mortality were similar in both groups. In the TEVAR group there was no death however, there was a case of lower extremity para-paresis. Five secondary interventions were performed for type I endoleaks. There was one peri-operative death in the open group but no case of paraplegia. The hospital stay was significantly shorter (p<0.0074) and Nursing total cost was lower (p<0.0001) for the TEVAR group. However Total hospital cost (p<0.0002), Direct cost (p<0.0002) and Operating room cost (p<0.0001) were significantly higher for TEVAR group. The net margin was significantly negative for TEVAR group, mean-$20,222 (p<0.0013).

CONCLUSIONS: There is significantly higher cost for TEVAR. This cost differential is primarily due to the stent graft cost. In the absence of significant benefit from morbidity and mortality this cost increase can not be ignored

AUTHOR DISCLOSURES: G. Tefera, None, J. Hoch, None; M. Mell, None; W. Turnipseed, None; C. Acher, None.