title: Comparative analysis of hospital costs of open and endovascular thoracic aortic repair.
abstract: BACKGROUND
  Endovascular technologies represent major advancements in treating descending thoracic aortic aneurysms (DTAA). We compared hospital charges of open thoracic aortic replacement (OTAR) with endovascular repair of thoracic aortic aneurysms (TEVAR).
  
  
  METHODS
  Retrospective analysis of hospital charges related to repair of DTAA (2000-2009). Charges were inflation adjusted for dollars in 2009.
  
  
  RESULTS
  There were 50 OTAR and 50 TEVAR patients. Open thoracic aortic replacement charges were $64 531 (interquartile range [IQR]: 49 000-108 515) versus $61 909 (IQR: 41 307-92 109) for TEVAR(P = .4). A total of 10 patients (10%) died before discharge, with 0 TEVAR deaths (P < .05). For OTAR, supply charges ($9167) accounted for 13% of total charges versus 56% for TEVAR ($40 468), P < .01. Open thoracic aortic replacement length of stay (LOS) was 12 days (6 days intensive care unit [ICU] stay); bed charges comprised 40% of the total charges. Thoracic endovascular aneurysm repair had lower LOS (5days with 2 days ICU stay, P < .001).
  
  
  CONCLUSIONS
  Descending thoracic aortic aneurysm repair remains a formidable operation with significant resource utilization. Thoracic endovascular aneurysm repair does not significantly reduce overall hospital charges due to device costs but demonstrates improved mortality, ICU, and total LOS.
authors.affiliation: Division of Vascular and Endovascular Surgery, John Hopkins Hospital, Baltimore, MD, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.forename: John A
authors.initials: JA
authors.lastname: Hundt
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.forename: Duke E
authors.initials: DE
authors.lastname: Cameron
authors.forename: James H
authors.initials: JH
authors.lastname: Black
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017545:Aortic Aneurysm, Thoracic / Q000191:economics / Q000401:mortality / Q000601:surgery*; D015142:Baltimore; D001807:Blood Vessel Prosthesis / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D003422:Critical Care / Q000191:economics; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome