Illig Karl A, Rhodes Jeffrey M, Sternbach Yaron, Green Richard M
Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
J Vasc Surg. 2003 Feb;37(2):323-30. doi: 10.1067/mva.2003.2.
The purpose of this study was to determine the financial and clinical impact of endoscopic saphenous vein harvest for lower extremity bypass.
The charts of all patients who underwent elective infrainguinal bypass with saphenous vein since we began using endoscopic harvest were analyzed, and the data were compared with our concomitant series of conventionally harvested bypasses. Wound complications were classified as cellulitis (I), an open/draining wound (II), or threatened/exposed graft (III). Actual hospital costs were analyzed in a subset of 84 patients without excessive preoperative stay or additional major inflow or flap procedures, and the financial data were converted to 2001 US dollars.
From March 1999 to December 2001, 242 bypasses were performed with open (n = 134) or endoscopic (n = 108) vein harvest techniques. Overall (34.1% versus 20.4%; P <.02) and class II (15.9% versus 6.5%; P <.03) wound complication rates and length of stay were significantly greater in the OPEN group. Financial subset analysis revealed a significant reduction in total cost ($6203 +/- $3326 versus $7456 +/- $3186; P <.01) in the ENDO versus the OPEN group. Readmissions for wound complications were more common in the OPEN versus the ENDO group (11.4% versus 4.1%; P <.03), resulting in an additional total cost of $204,557 versus $23,797, respectively. Patency and limb salvage at a mean of 7.1 months (range, 1 to 32 months) did not differ.
Endoscopic saphenous vein harvest results in a cost savings of more than $1200 per procedure during hospitalization and of almost $2200 per procedure including the costs of readmission. This is primarily from a shortened length of stay, a decreased rate of major wound infections, and a reduction in the need for early readmission.
本研究旨在确定内镜下大隐静脉获取用于下肢旁路移植术的财务和临床影响。
分析自我们开始使用内镜获取技术以来所有接受择期腹股沟下大隐静脉旁路移植术患者的病历，并将数据与我们同期进行的传统获取方式的旁路移植术系列进行比较。伤口并发症分为蜂窝织炎（I级）、开放性/有引流的伤口（II级）或移植血管受威胁/暴露（III级）。对84例无术前过长住院时间或额外的主要流入道或皮瓣手术的患者进行实际住院费用分析，并将财务数据换算为2001年美元。
从1999年3月至2001年12月，采用开放（n = 134）或内镜（n = 108）静脉获取技术进行了242例旁路移植术。总体伤口并发症发生率（34.1%对20.4%；P <.02）和II级并发症发生率（15.9%对6.5%；P <.03）以及住院时间在开放组显著更高。财务亚组分析显示，内镜组与开放组相比总成本显著降低（6203 ± 3326美元对7456 ± 3186美元；P <.01）。开放性伤口并发症再入院率在开放组比内镜组更常见（11.4%对4.1%；P <.03），分别导致额外总成本204,557美元和23,797美元。平均7.1个月（范围1至32个月）时的通畅率和肢体挽救率无差异。
内镜下大隐静脉获取术使住院期间每例手术节省成本超过1200美元，包括再入院费用在内每例手术节省近2200美元。这主要源于住院时间缩短、严重伤口感染率降低以及早期再入院需求减少。
