Midterm cost and effectiveness of thoracic endovascular aortic repair versus open repair
| Autor: | Adam W. Beck, Karen L. Walker, Charles T. Klodell, Robert J. Feezor, Philip J. Hess, Ashkan Karimi, Tomas D. Martin, Thomas M. Beaver |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Pulmonary and Respiratory Medicine
Diagnostic Imaging Male medicine.medical_specialty medicine.medical_treatment Cost-Benefit Analysis Aortic Diseases Anastomotic Leak Aorta Thoracic Comorbidity Kaplan-Meier Estimate Endovascular aneurysm repair Patient Readmission Blood Vessel Prosthesis Implantation Postoperative Complications Statistical significance medicine Paralysis Humans Hospital Costs Adverse effect Stroke Survival analysis Aged Retrospective Studies business.industry Endovascular Procedures Middle Aged medicine.disease Sternotomy Surgery Treatment Outcome Elective Surgical Procedures Costs and Cost Analysis Florida Open repair Female medicine.symptom Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | The Annals of thoracic surgery. 93(2) |
| ISSN: | 1552-6259 |
| Popis: | Thoracic endovascular aneurysm repair (TEVAR) has been rapidly introduced as a primary treatment modality for thoracic aortic diseases with limited data available on midterm to late-term outcomes.A retrospective single institution study comparing hospital and midterm outcomes and costs for TEVAR versus open elective repair of descending thoracic aneurysms was conducted. Fifty-seven patients were included between 2005 and 2007 (TEVAR=28; open=29) and were followed until May 2010.Patients in the TEVAR group were older (73.2 versus 62.3 years; p0.001). Hospital mortality was higher in the open repair group (10.3% versus 3.6%; p=0.611). There was no statistical difference in stroke, paraparesis or paralysis, sepsis, or renal failure; however, a composite major adverse event variable showed a higher complication with open repair versus TEVAR (37.9% versus 14.3%; p=0.043). Mean follow-up was 42.6 months for open repair versus 26.9 for TEVAR (p=0.002). Kaplan-Meier survival analysis showed the initial survival benefit for TEVAR was lost in less than 6 months; however, the difference did not reach statistical significance during follow-up (log-rank test p=0.232). Mean surveillance imaging costs for a TEVAR patient were $1,800.38 higher than for an open patient at 2 years. Compliance of TEVAR patients with follow-up imaging was 78%, 64%, 50%, and 42% at 1, 6, 12, and 24 months, respectively, and was even lower in those not registered in device trials.Patients in the TEVAR group had favorable early outcomes; however, midterm survival was reduced secondary to comorbidities. This study raises concern for the ongoing costs of surveillance imaging in TEVAR as well as patient compliance with follow-up. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|