Combined Aortic Debranching and Thoracic Endovascular Aneurysm Repair (TEVAR) Effective but at a Cost

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.