Variations in utilization and clinical outcomes for endoscopic sphenopalatine artery ligation and endovascular arterial embolization in a single multi-hospital network.

Autor: Lelegren M; Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States of America., Bhat K; Division of Vascular Surgery, Department of General Surgery, Emory University School of Medicine., Sheehan B; Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, VA, United States of America; Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, United States of America., Lamichhane R; Department of Clinical and Translational Sciences, John C Edwards School of Medicine, United States of America., Han JK; Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States of America., Lam KK; Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States of America. Electronic address: lamkk@evms.edu.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2021 Nov-Dec; Vol. 42 (6), pp. 103066. Date of Electronic Publication: 2021 Apr 16.
DOI: 10.1016/j.amjoto.2021.103066
Abstrakt: Purpose: Endoscopic sphenopalatine artery ligation (ESPAL) and endovascular arterial embolization (EAE) are increasingly common treatment options for patients with refractory epistaxis. The objective of this study was to compare the utilization pattern and clinical outcomes between these interventions within our single multi-hospital network.
Materials and Methods: A retrospective study of all patients undergoing ESPAL and/or EAE within any of the hospitals in a single healthcare network between 2008 and 2017 was conducted. We compared differences in procedure utilization with various hospital characteristics. Secondarily, we evaluated clinical outcomes and costs associated with each procedure.
Results: Forty-three ESPAL and 33 EAE procedures were performed across 7 hospitals, with the majority of procedures being performed at teaching institutions (65% and 91%, p = .013). The majority of both interventions were performed in larger hospitals and EAE patients were more likely to undergo inter-hospital transfer compared to ESPAL patients (48.5% and 16.3%, p = .02). Success rates for ESPAL and EAE were comparable (95% and 93%); however, the median direct cost of treatment for EAE was significantly higher than the cost for ESPAL ($12984.89 and $5002.02, p < .0001).
Conclusions: The majority of both ESPAL and EAE interventions were performed at teaching and larger hospitals. Transfers occurring prior to EAE may have been due to the limited availability of interventional radiology services, and likely contributed to the increased cost of treatment. ESPAL is a known cost-effective management strategy and should be considered early in treatment algorithms of refractory epistaxis.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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