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Erin H. Murphy, MD; Adam W. Beck, MD; G. Patrick Clagett, MD; J. Michael DiMaio, MD; Michael E. Jessen, MD; Frank R. Arko, MD

Arch Surg. 2009;144(3):222-227.

Objectives  To compare hybrid repair (HR) (aortic debranching and TEVAR) with conventional open thoracoabdominal and aortic arch repairs (OR), including a cost analysis.

Design  Retrospective cohort.

Setting  University hospital.

Patients  Thirty patients with thoracoabdominal aneurysms were evaluated between November 1, 2005, and December 31, 2006.

Interventions  There were 18 HRs and 12 ORs. Aortic abnormalities included the arch, visceral aorta, and arch/visceral aorta combined. Aortic debranching with TEVAR (HR) was performed at a single setting. Dacron grafts were used for OR, and branch vessels were bypassed. Hospital costs and reimbursements were obtained from the finance department.

Main Outcome Measures  Perioperative morbidity, mortality, and cost.

Results  Patients were significantly older in the HR group (mean [SD], 72 [8.9] vs 58 [17.4] years, P = .2). The HR group had significantly less blood loss (mean [SD], 1.7 [2.3] vs 4.8 [3.1] L, P = .004), transfusions (5.1 [5.9] vs 14.7 [7.8] units, P = .001), renal failure (0% vs 42.0%, P = .002), and pulmonary morbidity (17% vs 67%, P < .001); shorter intensive care unit stays (5.2 [4.8] vs 16.4 [12.9] days, P = .005); and shorter hospital length of stay (mean [SD], 11.6 [6.2] vs 20.8 [10.8] days, P = .01). There were no differences in mortality or spinal cord ischemia. There was no difference in mean direct hospital costs (HR: $59 435.70 vs OR: $49 341; P = .35). However, the mean cost margin per case was –34% for HR and +6.2% for OR (P = .04).

Conclusions  Improved clinical outcomes are seen after HR despite treatment of an older, sicker patient population. However, HR ultimately comes at a significant cost to the hospital, with a 34% loss in revenue per case.

Author Affiliations: Division of Vascular and Endovascular Surgery (Drs Murphy, Beck, Clagett, and Arko) and Department of Cardiovascular and Thoracic Surgery (Drs DiMaio and Jessen), University of Texas Southwestern Medical Center, Dallas.

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