The Clinical and Fiscal Impact of Endovascular Repair of Abdominal Aortic Aneurysms
Purpose: This study analyzed cost, reimbursement, application, and outcome differences between endovascular (ER) and open repair (OR) of abdominal aortic aneurysms (AAA) in a community hospital.
Method: A total of 187 consecutive elective AAA repairs by both methods (69 ER, 118 OR) performed at a single center between July 2001 and March 2003 were analyzed. Average values in postoperative clinical and fiscal demographics were calculated for this period.
Results: The average length of stay was higher for OR than ER (9.38 days versus 1.94 days, P < .001). Significant reductions in operative time (4 hours versus 2.67 hours) and intensive care unit use (100% versus 4.05%) were seen in the ER population. Total hospital costs were slightly higher for OR than ER ($21,989 versus $19,668) despite a considerable difference in cost of the grafts (>$11,000 for ER versus <$500 for OR). However, hospital charges were much lower for ER than OR ($32,660 versus $48,877), and there was an average loss of $4986 on ER cases versus a profit of $2064 on OR procedures. Thirty-day mortality was not significantly improved in the ER population (1.45% versus 2.54%, P = .05).
Conclusions: Our data suggest that ER offers improvements in hospital convalescence and operating room times but no improvements in fiscal impact or overall morbidity/ mortality rates when similar preoperative medical risks exist.
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