Conversion of open varicose veins surgery unit into a modern one-stop shop endo-venous unit: strategies and cost-effectiveness

Abstract

Purpose to provide a road map for converting varicose veins service to endovenous ablation and assess its process and outcome on patients with varicose veins. Patients and methods Retrospective assessment of prospectively recorded data for converting vein unit which exclusively did open varicose veins surgery (OS) (39 patients from September 2019 to February 2020) to endovenous radiofrequency ablation (ERFA) service (44 patients from March 2020 to January 2021). Results There was no statistical difference in theatre time between both interventions despite dealing with more complex cases in the ERFA group with more truncal veins (χ2 =11.950*, P<0.001*) and a higher number of stab avulsions (V number) (χ2 =217.889, P<0.001*). On the other hand, the overall cost was significantly lower in open group compared to ERFA (Mean±SD 1261±386 US$ and 1519.2±392 US$ respectively, P<0.001*. This statistical difference was reduced to P=0.041 when subgroup analysis only included cases with higher number of avulsions. In multivariate analysis, cost was associated with surgical duration and using ERFA however, less complications were recorded in ERFA group (χ2=4.419* P=0.036*) and recovery time was significantly longer in open group (8.90±2.44) than in ERFA group (6.0±1.06), P<0.001* Conclusion Converting varicose veins service to a modern ERFA is safe and effective when properly planned. ERFA is associated with shorter recovery and less theatre time and complications despite higher cost which becomes more cost-effective in cases with more truncal veins and avulsion sites.