title: The in-hospital costs of treating high-risk patients with fenestrated and branched endografts.
abstract: OBJECTIVE
  This study determined the 30-day morbidity and mortality and in-hospital costs of elective fenestrated (fEVAR) and branched (bEVAR) endovascular aneurysm repairs at a single academic institution and determined factors that influence them.
  
  
  METHODS
  All elective fEVAR or bEVAR patients treated between November 2007 and March 2014 in a Canadian academic hospital were included. Procedural details, 30-day morbidity and mortality rates, and cost of hospitalization were analyzed. Nonparametric bootstrap analysis was used to compare means between groups and calculate confidence intervals (CIs).
  
  
  RESULTS
  There were 84 consecutive fEVAR (n = 61) and bEVAR (n = 23) procedures. The 30-day mortality was 3.3% for fEVAR and 4.3% for bEVAR. Mean hospital stay was 7.2 ± 0.8 days for fEVAR and 12.6 ± 2.2 days for bEVAR. The mean cost of the index hospitalization was $57,000 for fEVAR and $91,000 for bEVAR. Device-related costs accounted for 55% of the total costs. The occurrence of intraoperative or postoperative events were used to further divide each of the fEVAR and bEVAR groups into "complicated hospitalization" (fEVAR, n = 10; bEVAR, n = 13) and "uncomplicated hospitalization" (fEVAR, n = 51; bEVAR, n = 10) groups. Device-related costs were not significantly different between the complicated and uncomplicated hospitalization groups (mean difference [95% CI] fEVAR: $3383 [-$3405 to $9809], P = .3; and bEVAR: $1930 [-$7892 to $11,288], P = .68). However, there were significant differences between the complicated and uncomplicated hospitalization groups in hospital length of stay (mean difference [95% CI] fEVAR: 8.1 [3.0-13.2] days, P = .001; and bEVAR: 10.8 [5.9-19.9] days, P = .002) and nondevice-related costs (mean difference [95% CI,] fEVAR: $25,843 [$11,689-$43,247], P = .001; and bEVAR; $20,326 [$9362-$36,615], P = .002).
  
  
  CONCLUSIONS
  bEVAR and fEVAR are expensive interventions. Intraoperative adverse events and postoperative systemic complications dramatically increase costs and length of stay. Measures to minimize complications will reduce hospitalization costs and improve patient outcomes.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: elrasheed.osman@uhn.ca.
authors.forename: Elrasheed
authors.initials: E
authors.lastname: Osman
authors.affiliation: Division of Vascular Interventional Radiology, Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kong T
authors.initials: KT
authors.lastname: Tan
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Leonard
authors.initials: L
authors.lastname: Tse
authors.affiliation: Division of Vascular Interventional Radiology, Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jaskolka
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Graham
authors.initials: G
authors.lastname: Roche-Nagle
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Interventional Radiology, Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Oreopoulos
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Barry
authors.initials: B
authors.lastname: Rubin
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lindsay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics; D017281:Cost of Illness; D017558:Elective Surgical Procedures; D057867:Endoleak / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D016896:Treatment Outcome