Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States of America.
Division of Vascular Surgery, Department of General Surgery, Emory University School of Medicine.
Am J Otolaryngol. 2021 Nov-Dec;42(6):103066. doi: 10.1016/j.amjoto.2021.103066. Epub 2021 Apr 16.
Endoscopic sphenopalatine artery ligation (ESPAL) and endovascular arterial embolization (EAE) are increasingly common treatment options for patients with refractory epistaxis. The objective of this study was to compare the utilization pattern and clinical outcomes between these interventions within our single multi-hospital network.
A retrospective study of all patients undergoing ESPAL and/or EAE within any of the hospitals in a single healthcare network between 2008 and 2017 was conducted. We compared differences in procedure utilization with various hospital characteristics. Secondarily, we evaluated clinical outcomes and costs associated with each procedure.
Forty-three ESPAL and 33 EAE procedures were performed across 7 hospitals, with the majority of procedures being performed at teaching institutions (65% and 91%, p = .013). The majority of both interventions were performed in larger hospitals and EAE patients were more likely to undergo inter-hospital transfer compared to ESPAL patients (48.5% and 16.3%, p = .02). Success rates for ESPAL and EAE were comparable (95% and 93%); however, the median direct cost of treatment for EAE was significantly higher than the cost for ESPAL ($12984.89 and $5002.02, p < .0001).
The majority of both ESPAL and EAE interventions were performed at teaching and larger hospitals. Transfers occurring prior to EAE may have been due to the limited availability of interventional radiology services, and likely contributed to the increased cost of treatment. ESPAL is a known cost-effective management strategy and should be considered early in treatment algorithms of refractory epistaxis.
对于难治性鼻出血患者，内镜蝶腭动脉结扎术（ESPAL）和血管内动脉栓塞术（EAE）是越来越常见的治疗选择。本研究的目的是比较在我们单一多医院网络内这两种干预措施的使用模式和临床结果。
对 2008 年至 2017 年间在单一医疗保健网络内的任何一家医院接受 ESPAL 和/或 EAE 的所有患者进行了回顾性研究。我们比较了不同医院特征与手术使用率之间的差异。其次，我们评估了与每种手术相关的临床结果和成本。
在 7 家医院中进行了 43 例 ESPAL 和 33 例 EAE 手术，其中大多数手术在教学医院进行（65%和 91%，p=0.013）。这两种干预措施大多数在较大的医院进行，与 ESPAL 患者相比，EAE 患者更有可能进行医院间转院（48.5%和 16.3%，p=0.02）。ESPAL 和 EAE 的成功率相当（95%和 93%）；然而，EAE 的治疗直接费用中位数明显高于 ESPAL（12984.89 美元和 5002.02 美元，p<0.0001）。
ESPAL 和 EAE 干预措施的大多数都在教学医院和较大的医院进行。EAE 之前发生的转移可能是由于介入放射学服务的有限可用性，这可能导致治疗费用增加。ESPAL 是一种已知的具有成本效益的管理策略，应在难治性鼻出血的治疗算法中尽早考虑。
