Lower Hospital and Operating Room Charges for Patients Undergoing Carotid Repair With Carotid Endarterectomy Versus Transcervical Carotid Artery Revascularization

Abstract

Transcervical carotid artery revascularization (TCAR) has become an increasingly popular method for the treatment of carotid artery stenosis, especially because trial data have demonstrated a stroke risk comparable to that for carotid endarterectomy (CEA). Recent data have suggested that TCAR might be cost-effective; however, the costs associated with using this new technology have not been thoroughly evaluated. A retrospective cohort review was conducted of patients at a single institution undergoing either TCAR or CEA from January 2019 to December 2020. Patient demographics, including race, gender, comorbidities, length of stay, and complications, were recorded. Additionally, the total operating room (OR) charges and hospitalization charges were recorded. Patients who had undergone combined procedures (coronary artery bypass grafting or transcatheter aortic valve replacement during hospitalization) were excluded. Of 234 patients, 38 had undergone TCAR and 196 had undergone CEA. Both cohorts were well matched for demographics and comorbid conditions. The length of stay was similar between the TCAR and CEA cohorts (1.32 vs 1.57 days; P = .254). The overall OR charges were greater for the TCAR group than for the CEA group ($60,996.72 vs $49,078.75; P < .001). The total hospital charges were similar for the TCAR group vs the CEA group (67,921.38 vs 63,308.97; P = .317). When selecting for patients with a single-day length of stay, the total hospital charges were greater for TCAR than for CEA ($65,278.17 vs $55,865.73; P < .001; Fig). In the TCAR group, the primary reason for the overall difference in costs appeared to be the OR charges. The hospital charges after the exclusion of the OR charges were similar between the TCAR and CEA groups ($4188.71 vs $6604.38; P = .08). One notable difference was that the TCAR group was more likely to require a higher level of OR billing than the CEA group (15% vs 5%; P = .03). The hospital charges were similar for patients who had undergone TCAR vs CEA overall but were lower for the CEA group when examining patients with only 1 day in the hospital. The primary reason for this charge difference appeared to be the OR charges, which were significantly greater for the patients who had undergone TCAR ($60,996.72 vs 49,078.75; P < .001). Cost containing efforts for treating patients with carotid artery stenosis should focus on reducing the charges associated with TCAR.