Comparison of perioperative costs with fast-track vs standard endovascular aneurysm repair
Received 30 March 2019
Accepted for publication 17 August 2019
Published 3 September 2019 Volume 2019:15 Pages 385—393
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 3
Editor who approved publication: Dr Harry Struijker-Boudier
Zvonimir Krajcer1, Venkatesh G Ramaiah2, Esteban A Henao3, Wayne K Nelson4, Mohammed M Moursi5, Hiranya A Rajasinghe6, Louise H Anderson7, Larry E Miller8
1Department of Cardiology, CHI St. Luke’s Health, Houston, TX, USA; 2Department of Vascular Surgery, Honor Health, Scottsdale, AZ, USA; 3Department of Vascular Surgery, Heart Hospital of New Mexico, Albuquerque, NM, USA; 4Department of Vascular Surgery, St. Charles Hospital, Bend, OR, USA; 5Department of Vascular Surgery, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA; 6Department of Vascular Surgery, NCH Healthcare Systems, Naples, FL, USA; 7Technomics Research, Long Lake, MN, USA; 8Miller Scientific Consulting, Inc., Asheville, NC, USA
Correspondence: Zvonimir Krajcer
Department of Cardiology, CHI St. Luke’s Health, 6624 Fannin #2780, Houston, TX 77005, USA
Background: Perioperative health care utilization and costs in patients undergoing elective fast-track vs standard endovascular aneurysm repair (EVAR) remain unclear.
Methods: The fast-track EVAR group included patients treated with a 14 Fr stent graft, bilateral percutaneous access, no general anesthesia or intensive care monitoring, and next-day hospital discharge. The standard EVAR group was identified from Medicare administrative claims using a matching algorithm to adjust for imbalances in patient characteristics. Hospital outcomes included operating room time, intensive care monitoring, hospital stay, secondary interventions, and major adverse events (MAEs). Perioperative outcomes occurring from hospital discharge to 30 days postdischarge included MAE, secondary interventions, and unrelated readmissions.
Results: Among 1000 matched patients (250 fast-track; 750 standard), hospital outcomes favored the fast-track EVAR group, including shorter operating room time (2.30 vs 2.83 hrs, P<0.001), shorter hospital stay (1.16 vs 1.69 d, P<0.001), less need for intensive care monitoring (4.4% vs 48.0%, P<0.001), and lower secondary intervention rate (0% vs 2.4%, P=0.01). Postdischarge outcomes also favored fast-track EVAR with a lower rate of MAE (0% vs 7.2%, P<0.001) and all-cause readmission (1.6% vs 6.8%, P=0.001). The total cost to the health care system during the perioperative period was $26,730 with fast-track EVAR vs $30,730 with standard EVAR. Total perioperative health care costs were $4000 (95% CI: $3130–$4830) lower with fast-track EVAR vs standard EVAR, with $2980 in savings to hospitals and $1030 savings to health care payers.
Conclusion: A fast-track EVAR protocol using a 14 Fr stent graft resulted in shorter procedure time, lower intensive care utilization, faster discharge, lower incidence of MAE, lower readmission rates, and lower perioperative costs compared to standard EVAR.
Keywords: abdominal aortic aneurysm, cost, EVAR, fast-track, Medicare, percutaneous, perioperative
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