A. Cha1, V. Dombrovskiy1, N. Nassiri1, R. Shafritz1, S. Rahimi1 1Robert Wood Johnson – UMDNJ,Vascular Surgery,New Brunswick, NJ, USA
Introduction: Endovascular repair has shown improved early survival and decreased postoperative complications in treating ruptured abdominal aortic aneurysms. However, less is understood about hospital resource utilization for endovascular compared to open surgical repair of ruptured abdominal aortic aneurysms. The purpose of this study was to evaluate and compare hospital length of stay and cost for these two procedures.
Methods: Patients with ruptured abdominal aortic aneurysms who underwent endovascular repair or open surgery were queried from MedPAR files 2005-2009. Because hospital length of stay and cost were not normally distributed and highly skewed, each parameter estimate is presented as median and intergroup comparison is performed with Wilcoxon rank sum test.
Results: Among 8,480 selected Medicare patients 1,939 underwent endovascular repair and 6,541 experienced open surgery. Total hospital and ICU (intensive care unit) length of stay after endovascular repair (6 days and 2 days, respectively) were significantly shorter than after open surgery (9 days and 4 days; P<0.0001 for both). Total hospital cost for all services provided to beneficiary during hospital stay after endovascular repair was greater than after open surgery ($100,875 vs $89,035; P<0.0001) but ICU cost for endovascular repair ($5,516) was significantly smaller than for open surgery ($8,600; P<0.0001). The following costs in the endovascular repair group were also less expensive than in the open surgery group: for anesthesia services ($1,673 vs $1,866; P=0.0033), laboratory costs ($6,736 vs $10,396; P<0.0001), pharmaceutical costs ($5,619 vs $11,026; P<0.0001). However, cost of medical/surgical supplies among patients with endovascular repair ($36,710) was significantly greater than among those with open surgery ($8,766; p<0.0001) that resulted in more expensive total hospital cost for endovascular repair.
Conclusion: Use of endovascular technique for repair of ruptured abdominal aortic aneurysms compared to open surgery significantly reduces total hospital and ICU length of stay that can increase hospital capacity. Because of the expensive cost of supplies for endovascular repair, this procedure slightly increases total hospital cost, but provides financial savings for many services related to hospital stay.