Open Surgical Repair Group Research Articles

Cost comparison of aortic aneurysm endograft exclusion versus open surgical repair

Background: Shrinking health care resources impose a requirement to evaluate new technology for cost as well as clinical effectiveness. We studied an initial clinical experience with endograft treatment (EAG) of abdominal aortic aneurysm (AAA) at the beginning of an endovascular program in comparison with open surgical repair (OSR), which had been in use for decades. Methods: From March 1997 to April 1998, the utilization of hospital resources, actual cost, clinical descriptors, and treatment outcomes were recorded for two contemporaneous groups, each having 16 consecutive patients with AAA, treated with either EAG or OSR. Subjects were not randomized; EAG treatment was based on predetermined exclusion/inclusion criteria. Statistical comparison was by either Fisher’s exact test or the Wilcoxon rank sum test. Results: There were no differences between OSR and EAG in age, gender, AAA size, smoking status, diabetes, ischemic heart disease, history of coronary artery bypass grafts, previous vascular surgery, or other comorbidity. There were no deaths in either group. Patients treated by EAG procedure had significantly lower length of hospital stay, length of stay in intensive care unit, time in operating room, and cost of operating room without graft ( P <0.05). Cost of operating room with graft was less in OSR group ( P <0.001). In-hospital imaging costs specific to the EAG procedure were $1,370.45 ± $66.92 (range $911.58 to $1,826.76). Total costs were not significantly different between the OSR and EAG, $12,714.19 ± $1,115.52 and $12,904.99 ± $494.69, respectively ( P = 0.26). Conclusions: Total hospital cost is not different for the two treatments studied despite differences in experience with their use. Endograft treatment utilizes significantly less hospital resources than open surgical repair. The endograft prosthesis contributes a significant cost increment that may decline with expanded use.

Initial experience with endovascular aneurysm repair: Comparison of early results with outcome of conventional open repair

Purpose: To determine the safety, effectiveness, and problems encountered with endovascular repair of abdominal aortic aneurysm (AAA). Initial experience with endoluminal stent grafts was examined and compared with outcome for a matched concurrent control group undergoing conventional operative repair of AAA. Methods: Over a 3-year period, 30 patients underwent attempts at endovascular repair of infrarenal AAA. Of the 28 (93%) successfully implanted endografts, 8 were tube endografts, 8 bifurcated grafts, and 12 aortouniiliac grafts combined with femorofemoral bypass. Most of the procedures were performed in the past year because the availability of bifurcated and aortoiliac endografts markedly expanded the percentage of patients with AAA who might be treated with endoluminal methods. The follow-up period ranged from 1 to 44 months, with a mean value of 11 months. Results: Endovascular procedures demonstrated significant advantages with respect to reduced blood loss (408 versus 1287 ml), use of an intensive care unit (0.1 versus 1.75 days), length of hospitalization (3.9 versus 10.3 days), and quicker recovery (11 versus 47 days). Although the total number of postoperative complications was identical for the two groups, the nature of the complications differed considerably. Local and vascular complications characteristic of endovascular repair could frequently be corrected at the time of the procedure and tended to be less severe than systemic or remote complications, which predominated among the open surgical repair group. On an intent-to-treat basis, 23 (77%) of the 30 AAAs were successfully managed with endoluminal repair. The seven (23%) failures were attributable to two immediate conversions caused by access problems, three persistent endoleaks, one late conversion caused by AAA expansion, and one late rupture. Conclusions: Although less definitive than those for conventional operations, these early results suggest that endovascular AAA repair offers considerable benefits for appropriate patients. The results justify continued application of this method of AAA repair, particularly in the treatment of older persons at high risk. (J Vasc Surg 1998;27:992-1005.)

Management of rotator cuff tears: A comparison of arthroscopic debridement and surgical repair

In a prospective study, 87 consecutive patients with 88 chronic, full-thickness tears of the rotator cuff were randomly assigned to either open surgical tendon repair and anterior acromioplasty (50 shoulders) or arthroscopic debridement and subacromial decompression (38 shoulders). All patients were reexamined 2 to 5 years after the operation with the University of California at Los Angeles 35-Point Scale for Pain and Function of the Shoulder. The average ratings were 30.5 (rotator cuff repair) and 25.1 (arthoscopic debridement/decompression) for each group. The open surgical repair group faired significantly better than the arthroscopic debridement group (p = .0028). Thirteen required subsequent procedures, four with tendon repair and nine with decompression. Five in the decompression group experienced cuff tear arthropathy. Surgical repair of full-thickness rotator cuff tears provided results superior to those of arthroscopic debridement and subacromial decompression.