Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
J Surg Res. 2024 Jul;299:17-25. doi: 10.1016/j.jss.2024.04.003. Epub 2024 Apr 29.
Physician-modified endografts (PMEGs) have been used for repair of thoracoabdominal aortic aneurysms (TAAAs) for 2 decades with good outcomes but limited financial data. This study compared the financial and clinical outcomes of PMEGs to the Cook Zenith-Fenestrated (ZFEN) graft and open surgical repair (OSR).
A retrospective review of financial and clinical data was performed for all patients who underwent endovascular or OSR of juxtarenal aortic aneurysms and TAAAs from January 2018 to December 2022 at an academic medical center. Clinical presentation, demographics, operative details, and outcomes were reviewed. Financial data was obtained through the institution's finance department. The primary end point was contribution margin (CM).
Thirty patients met inclusion criteria, consisting of twelve PMEG, seven ZFEN, and eleven open repairs. PMEG repairs had a total CM of -$110,000 compared to $18,000 for ZFEN and $290,000 for OSR. Aortic and branch artery implants were major cost-drivers for endovascular procedures. Extent II TAAA repairs were the costliest PMEG procedure, with a total device cost of $59,000 per case. PMEG repairs had 30-d and 1-y mortality rates of 8.3% which was not significantly different from ZFEN (0.0%, P = 0.46; 0.0%, P = 0.46) or OSR (9.1%, P = 0.95; 18%, P = 0.51). Average intensive care unit and hospital stay after PMEG repairs were comparable to ZFEN and shorter than OSR.
Our study suggests that PMEG repairs yield a negative CM. To make these cases financially viable for hospital systems, device costs will need to be reduced or reimbursement rates increased by approximately $8800.
医生改良的血管内移植物（PMEG）已被用于治疗胸主动脉腹主动脉瘤（TAAA）超过 20 年，疗效良好，但财务数据有限。本研究比较了 PMEG 与 Cook Zenith-Fenestrated（ZFEN）移植物和开放手术修复（OSR）的财务和临床结果。
对 2018 年 1 月至 2022 年 12 月在一家学术医疗中心接受腹主动脉瘤和 TAAA 腔内或 OSR 的所有患者的财务和临床数据进行回顾性分析。回顾了临床表现、人口统计学、手术细节和结果。通过机构财务部门获取财务数据。主要终点是边际贡献（CM）。
30 名患者符合纳入标准，包括 12 例 PMEG、7 例 ZFEN 和 11 例开放修复。PMEG 修复的总 CM 为-110,000 美元，而 ZFEN 为 18,000 美元，OSR 为 290,000 美元。血管内手术的主动脉和分支动脉植入物是主要的成本驱动因素。II 型 TAAA 修复是最昂贵的 PMEG 手术，每例病例的设备总成本为 59,000 美元。PMEG 修复的 30 天和 1 年死亡率分别为 8.3%，与 ZFEN（0.0%，P=0.46；0.0%，P=0.46）或 OSR（9.1%，P=0.95；18%，P=0.51）无显著差异。PMEG 修复后的重症监护病房和住院时间与 ZFEN 相似，短于 OSR。
我们的研究表明，PMEG 修复产生负 CM。为了使这些病例对医院系统具有经济可行性，需要降低设备成本或提高报销率约 8800 美元。
