RT Journal
A1 Murphy EH, Beck AW, Clagett G, DiMaio J, Jessen ME, Arko FR
T1 COmbined aortic debranching and thoracic endovascular aneurysm repair (tevar) effective but at a cost
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD March 16
VO 144
IS 3
SP 222
OP 227
DO 10.1001/archsurg.2009.3
UL http://dx.doi.org/10.1001/archsurg.2009.3
AB Objectives 
    To compare hybrid repair (HR) (aortic debranching and TEVAR) with conventional open thoracoabdominal and aortic arch repairs (OR), including a cost analysis.Design 
    Retrospective cohort.Setting 
    University hospital.Patients 
    Thirty patients with thoracoabdominal aneurysms were evaluated between November 1, 2005, and December 31, 2006.Interventions 
    There were 18 HRs and 12 ORs. Aortic abnormalities included the arch, visceral aorta, and arch/visceral aorta combined. Aortic debranching with TEVAR (HR) was performed at a single setting. Dacron grafts were used for OR, and branch vessels were bypassed. Hospital costs and reimbursements were obtained from the finance department.Main Outcome Measures 
    Perioperative morbidity, mortality, and cost.Results 
    Patients were significantly older in the HR group (mean [SD], 72 [8.9] vs 58 [17.4] years, P = .2). The HR group had significantly less blood loss (mean [SD], 1.7 [2.3] vs 4.8 [3.1] L, P = .004), transfusions (5.1 [5.9] vs 14.7 [7.8] units, P = .001), renal failure (0% vs 42.0%, P = .002), and pulmonary morbidity (17% vs 67%, P < .001); shorter intensive care unit stays (5.2 [4.8] vs 16.4 [12.9] days, P = .005); and shorter hospital length of stay (mean [SD], 11.6 [6.2] vs 20.8 [10.8] days, P = .01). There were no differences in mortality or spinal cord ischemia. There was no difference in mean direct hospital costs (HR: $59 435.70 vs OR: $49 341; P = .35). However, the mean cost margin per case was −34% for HR and +6.2% for OR (P = .04).Conclusions 
    Improved clinical outcomes are seen after HR despite treatment of an older, sicker patient population. However, HR ultimately comes at a significant cost to the hospital, with a 34% loss in revenue per case.