Combined aortic debranching and thoracic endovascular aneurysm repair (TEVAR) effective but at a cost.
OBJECTIVE
To compare hybrid repair (HR) (aortic debranching and TEVAR) with conventional open thoracoabdominal and aortic arch repairs (OR), including a cost analysis.


METHODS
Retrospective cohort.


METHODS
University hospital.


METHODS
Thirty patients with thoracoabdominal aneurysms were evaluated between November 1, 2005, and December 31, 2006.


METHODS
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.


METHODS
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.
Murphy
Erin H
EH
Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75903, USA.
Beck
Adam W
AW
Clagett
G Patrick
GP
DiMaio
J Michael
JM
Jessen
Michael E
ME
Arko
Frank R
FR
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000191:economics*