title: Combined aortic debranching and thoracic endovascular aneurysm repair (TEVAR) effective but at a cost.
abstract: 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.
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75903, USA.
authors.forename: Erin H
authors.initials: EH
authors.lastname: Murphy
authors.forename: Adam W
authors.initials: AW
authors.lastname: Beck
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
authors.forename: J Michael
authors.initials: JM
authors.lastname: DiMaio
authors.forename: Michael E
authors.initials: ME
authors.lastname: Jessen
authors.forename: Frank R
authors.initials: FR
authors.lastname: Arko
mesh_terms: 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*