The Clinical and Fiscal Impact of Endovascular Repair of Abdominal Aortic Aneurysms

Abstract

This study analyzed cost, reimbursement, application, and outcome differences between endovascular (ER) and open repair (OR) of abdominal aortic aneurysms (AAA) in a community hospital. A total of 187 consecutive elective AAA repairs by both methods (69 ER, 118 OR) performed at a single center between July 2001 and March 2003 were analyzed. Average values in postoperative clinical and fiscal demographics were calculated for this period. The average length of stay was higher for OR than ER (9.38 days versus 1.94 days, P < .001). Significant reductions in operative time (4 hours versus 2.67 hours) and intensive care unit use (100% versus 4.05%) were seen in the ER population. Total hospital costs were slightly higher for OR than ER (21,989 dollars versus 19,668 dollars) despite a considerable difference in cost of the grafts (>11,000 dollars for ER versus <500 dollars for OR). However, hospital charges were much lower for ER than OR (32,660 dollars versus 48,877 dollars), and there was an average loss of 4986 dollars on ER cases versus a profit of 2064 dollars on OR procedures. Thirty-day mortality was not significantly improved in the ER population (1.45% versus 2.54%, P = .05). Our data suggest that ER offers improvements in hospital convalescence and operating room times but no improvements in fiscal impact or overall morbidity/ mortality rates when similar preoperative medical risks exist.