title: Cost analysis of iliac stenting performed in the operating room and the catheterization lab: A case-control study.
abstract: BACKGROUND
  Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these locations.
  
  
  METHODS
  Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures. Immediate and two-year outcomes were observed. Patient demographics, perioperative details, physician billings, and hospital costs were recorded. Multivariable regression was used to adjust costs by patient and perioperative cost drivers.
  
  
  RESULTS
  Fifty-one procedures (49%) were performed in the OR and 54 (51%) in the CL. Mean age was 57, and 44% were female. Severe cases were more often performed in the OR (RC ≥ 4; 42% vs. 11%, P < 0.001) and were associated with increased total costs (P < 0.01). OR procedures more often utilized additional stents (stents ≥ 2; 61% vs. 46%, P = 0.214), thrombolysis (12% vs. 0%, P = 0.011), cut-down approach (8% vs. 0%, P = 0.052), and general anesthesia (80% vs. 0%, P < 0.001): these were all associated with increased costs (P < 0.05). After multivariable regression, location was not a predictor of procedure room or total costs but was associated with increased professional fees. Same-stay (5%) and post-discharge reintervention (33%) did not vary by location.
  
  
  CONCLUSIONS
  The OR was associated with increased length of stay, more ICU admissions, and increased total costs. However, OR patients had more severe disease and therefore often required more aggressive intervention. After controlling for these differences, procedure venue per se was not associated with increased costs, but OR cases incurred increased professional fees due to dual-provider charges. Given the similar clinical results between venues, it seems reasonable to perform most stenting in the CL or utilize conscious sedation in the OR.
authors.affiliation: University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Sooyeon
authors.initials: S
authors.lastname: Kim
authors.affiliation: University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Sage P
authors.initials: SP
authors.lastname: Kramer
authors.affiliation: University of Kentucky Department of Surgery, Lexington, KY, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Dugan
authors.affiliation: University of Kentucky Section of Vascular Surgery, Lexington, KY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Minion
authors.affiliation: University of Kentucky Department of Cardiovascular Medicine, Lexington, KY, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Gurley
authors.affiliation: University of Kentucky Department of Surgery, Lexington, KY, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
authors.affiliation: University of Kentucky Division of Cardiothoracic Surgery, Lexington, KY, USA.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferraris
authors.affiliation: University of Kentucky Division of Cardiothoracic Surgery, Lexington, KY, USA. Electronic address: Ssaha2@uky.edu.
authors.forename: Sibu P
authors.initials: SP
authors.lastname: Saha
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002406:Catheterization, Peripheral / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics*; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000191:economics*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Anesthesia type; Cost analysis; Iliac stenting