Endovascular, transperitoneal, and retroperitoneal abdominal aortic aneurysm repair: Results and costs

Purpose: Contemporary treatment of abdominal aortic aneurysms (AAA) include s transabdominal (TA), retroperitoneal (RP), and endovascular (EV) repair. This study compares the cost and early (30-day) results of a consecutive se ries of AAA. repair by means of these three methods in a single institution . Methods: A total of 125 consecutive AAA. repairs between February 1993 and August 1997 were reviewed. Risk factors, 30-day morbidity and mortality rat es, and hospital stay and cost were analyzed according to method of repair (TA, RP, EV). Cost was normalized by means of a conversion factor to mainta in confidentiality. Cost analysis includes conversion to TA repair (intent to treat) in the EV group. Results: One hundred twenty-five AAA repairs were performed with the TA (n = 40), RP (n = 24), or EV (n = 61) approach. Risk factors among the groups (age, coronary artery disease, hypertension, diabetes, chronic obstructive pulmonary disease, and cigarette smoking) were not statistically different, and thus the groups were comparable. The average estimated blood loss was significantly lower for EV (300 mi,) than for RF (700 mL) and TA (786 mL; P >.05). Statistically significant higher cost for TA and RP for pharmacy an d clinical laboratories (likely related to increased length of stay [LOS]) and significantly higher cost for EV in supplies and radiology (significant ly reducing cost savings in LOS) were revealed by means of an itemized cost analysis. Operating room cost was similar for EV, TA, and RP. There were s ix perigraft leaks (9.6%) and six conversions to TA (9.6%) in the EV group. Conclusion: There were no statistically significant differences in mortalit y rates among TA, RP, and EV. Respiratory failure was significantly more co mmon after TA repair, compared with RP or EV, whereas wound complications w ere more common after RP. Overall cost was significantly higher for TA repa ir, with no significant difference in cost between EV and RP EV repair sign ificantly shortened hospital stay and intensive care unit (ICU) use and had a lower morbidity rate. Cost savings in LOS were significantly reduced in the EV group by the increased cost of supplies and radiology, accounting fo r a similar cost between EV and RP. Considering the increased resource use preoperatively and during follow-up for EV patients, the difference in cost between TA and EV may be insignificant. EV repair is unlikely to save mone y for the health care system; its use is likely to be driven by patient and physician preference, in view of a significant decrease in the morbidity r ate and length of hospital stay.