| Abstrakt: |
Introduction: The objective of this single enterprise-wide study was to compare treatment, outcomes, and associated cost of open surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAAs). Each technique is associated with risks and benefits, and the best approach for TAAA repair remains heavily debated within the vascular surgery field. Understanding the risks/benefits of one technique over the other is necessary for effective education of patients, physicians, servicing hospitals, and government regulatory agencies. Additionally, assessment of cost is important for patients and institutions in responsible medical management of an aging population with often complex, co-existing, comorbidities. Methods: An enterprise-wide retrospective study was conducted that identified patients with thoracoabdominal aneurysms having undergone either an open surgical repair or endovascular repair between 2009-2018. Patient demographics, comorbidities, operative specifics and outcomes, and hospital admissions at 30 days and at one year were analyzed. Hospital and professional costs of the repair and any additional admissions at these time points were also recorded. Data were analyzed for statistical significance using the student t-test or Fisher exact test. Results: Within the study period, 92 patients with a diagnosed TAAA underwent surgical repair. Sixteen patients had an open repair and 76 underwent endovascular repair. Average age and patient demographics were similar between groups. Common preexisting comorbidities including coronary artery disease, hypertension, hyperlipidemia, and being a previous or current smoker were comparable between treatment arms. Aortic diameters in open and endovascular cohorts had no significant difference (56.3 ± 17.4 and 67.2 ± 11.7 mm, p=0.255). Comparisons of the procedure itself showed open repair time was significantly shorter compared to endovascular repair (262 ± 118 vs. 341 ± 165 minutes, p < 0.05). Procedural comparisons also showed open repair resulted in significantly higher intraoperative blood loss compared to endovascular (2120 ± 1,859.7 and 351.6 ± 157.4 mL, p < 0.005). In-hospital mortality and mortality at less than 30 days was improved with the endovascular technique (12.5 vs. 3.9 percent, open vs. endovascular) however mortality was equalized by 1 year postoperative (12.5 vs. 13.2 percent, open vs. endovascular). Analysis of cost showed the average initial hospital bill for open repair compared to endovascular to be significantly less (difference of 344 ± 88 $1,000, p < 0.0001) with the average hospital bill for inpatient admissions within the first year having no significant difference (difference of 35.8 ± 66.7 $1,000, p = 0.126). Conclusions: TAAA endovascular repair within this enterprise is a safe option for patients and offers early mortality benefit over open repair. Initial cost of the endovascular repair is significantly higher compared to the traditional open surgical approach, however there is no difference in cost for all cause readmissions within the first year. [ABSTRACT FROM AUTHOR] |
