title: A Cost Analysis of Regional Versus General Anesthesia for Carotid Endarterectomy.
abstract: BACKGROUND
  Medical care in the United States has evolved into a more cost-conscious value-based health care system that necessitates a comparison of costs when there are alternative interventions considered to be acceptable in the treatment of a disease. This study compares the cost differences between regional anesthesia (RA) and general anesthesia (GA) for carotid endarterectomy (CEA).
  
  
  METHODS
  Data from 346 consecutive patients who underwent CEA between January 2012 and September 2014 were retrospectively reviewed for the type of anesthesia used, outcomes data, and cost variables. Overall hospital day costs were compared between RA and GA. Medians and interquartile ranges were compared using Wilcoxon-Mann-Whitney test. A P < 0.05 was considered statistically significant using 2-sided tests.
  
  
  RESULTS
  Median overall costs for GA were significantly higher than median costs for RA (medians [with interquartile ranges], $10,140 [$7,158-$12,658] versus $7,122 [$5,072-$8,511], P < 0.001). Median total operative time for GA was significantly longer than median time for RA (168 [144-188] versus 134 [115-147] min, P < 0.001). Median in-hospital length of stay (LOS) for GA was significantly longer compared with RA (2.0 vs 1.2 days, P < 0.001). Patients who received GA were also more likely to be admitted to the intensive care unit.
  
  
  CONCLUSIONS
  Decreased cost, operating room expenses, postoperative resources, and overall LOS were observed for individuals who underwent RA for CEA as compared with GA. In summary, RA is more cost-effective and should be the optimal choice when clinically appropriate.
authors.affiliation: Department of Neurological Surgery, George Washington University Medical Center, Washington, DC.
authors.forename: Alan
authors.initials: A
authors.lastname: Siu
authors.affiliation: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Jigarkumar
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Prentice
authors.affiliation: George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Cappuzzo
authors.affiliation: Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Hashemi
authors.affiliation: Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA. Electronic address: Dipankar.Mukherjee@inova.org.
authors.forename: Dipankar
authors.initials: D
authors.lastname: Mukherjee
mesh_terms: D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000191:economics*; D000768:Anesthesia, General / Q000009:adverse effects / Q000191:economics*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D018803:Models, Economic; D009873:Operating Rooms / Q000191:economics; D061646:Operative Time; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome