Subfascial endoscopic perforator surgery conserves hospital resources

Innovations in the management of venous disorders have included subfascial endoscopic perforator surgery (SEPS). Information on resource utilization o f this procedure is limited. Comparison of sequential cohorts of patients t reated for leg venous hypertension by SEPS versus open perforating vein lig ation (OPL) was performed to quantify the impact on hospital resource utili zation and length of stay. At the Jobst Vascular Center, the last OPL was p erformed in June 1995 and the first SEPS was performed in January 1994. The authors compared the last 34 consecutive OPL procedures with the first 33 consecutive SEPS operations. Both groups had similar clinical indications. Variables describing utilization of hospital resources were assessed from a computer database compiled at time of treatment and compared by use of t t est and chi-square statistics. Charges were selected as representation of h ospital resources. SEPS length of stay, 2.3 +/- 1.8 (sd) days was significa ntly less than OPL, 4.5 +/- 2.7 days (p < 0.001) with concomitant reduction in physician bedside visits, 4.8 +/- 13.9 for SEPS versus 8.0 +/- 5.3 for OPL (p = 0.007). Total hospital charges in dollars, adjusted for sequential annual increments, were similar: 8,093 +/- 3,811 for OPL versus 7,278 +/- 1,716 for SEPS (p = 0.27). When OPL and SEPS were compared respectively, th ere were no significant differences in patient age, 58 +/- 14 versus 53 +/- 12 years; gender distribution, 62% women versus 42%; active ulcer status, 88% versus 85%; advanced admission testing, 41% versus 58%; use of venograp hy, 97% versus 88%; use of general anesthesia, both 82%; or concomitant vei n stripping, 65% versus 58% (p > 0.1). SEPS anesthesia time was longer, 136 +/- 10 versus 122 +/- 28 minutes (p = 0.01), but not clinically significan t. SEPS reduced length of hospital stay and number of physician bedside vis its compared with OPL. Total hospital charges may be further reduced as exp erience with this procedure accumulates.