P-087 - OPEN VERSUS ENDOVASCULAR REPAIR WITH COVERED STENTS FOR COMPLEX AORTO-ILIAC OCCLUSIVE DISEASE: IN-HOSPITAL COST ANALYSIS RESULTS.

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Colacchio E.C. (University of Padova - Vascular and Endovascular Surgery Unit - Department of Cardiac, Pulmonary, Vascular Sciences and Public Health ~ Padova ~ Italy) , Squizzato F. (University of Padova - Vascular and Endovascular Surgery Unit - Department of Cardiac, Pulmonary, Vascular Sciences and Public Health ~ Padova ~ Italy) , Boemo D.G. (University of Padova - Vascular and Endovascular Surgery Unit - Department of Cardiac, Pulmonary, Vascular Sciences and Public Health ~ Padova ~ Italy) , Grego F. (University of Padova - Vascular and Endovascular Surgery Unit - Department of Cardiac, Pulmonary, Vascular Sciences and Public Health ~ Padova ~ Italy) , Piazza M. (University of Padova - Vascular and Endovascular Surgery Unit - Department of Cardiac, Pulmonary, Vascular Sciences and Public Health ~ Padova ~ Italy) , Antonello M. (University of Padova - Vascular and Endovascular Surgery Unit - Department of Cardiac, Pulmonary, Vascular Sciences and Public Health ~ Padova ~ Italy)
Introduction:
The aim of this work is to compare in-hospital detailed costs of hospitalisation of open and endovascular techniques in order to evaluate cost-effectiveness of complex aorto-iliac occlusive disease (AIOD) revascularisation.
Methods:
Our study included 100 patients who underwent AIOD revascularisation from May 2008 to February 2018, subsequently divided in two groups: open surgical repair (OSR) and endovascular repair (ER). Only two types of intervention were included: aorto-bifemoral by-pass (ABF) and covered iliac kissing stenting (CKS). Aneurysmal and/or dissecting pathology, patients who underwent a multi-level revascularisation during the same hospitalisation, and patients who underwent endovascular repair with bare metal stents were excluded from the analysis. We compared the two groups' related costs with univariate and multivariate logistic regression models. Cox-proportional hazard models were used to identify predictors of long-term mortality and primary patency.
Results:
Each group included 50 patients, and all patients underwent bilateral iliac axis revascularisation. Overall long-term survival and primary patency at 36 months were not influenced by the type of revascularisation on multivariate analysis (HR 2.09 CI 95% 0.90 - 4.84 p= .082 for overall survival, and HR 1.82 CI 95% 0.56 - 6.16 p= .302, respectively). OSR presented significantly higher in-hospital medical complications (p= .003). Both requiring and not requiring reintervention surgical complications did not differ between the two groups (p= .487 and p= .268, respectively). No differences were found in the total cumulative cost of hospitalisation, including ward, ICU and operating room. In a multivariate logistic model, belonging to the OSR group was a predisposing factor to higher ICU-related costs, while belonging to the ER was a predisposing factor to higher implanted material costs. However, higher total hospitalisation costs were not significantly associated with either one or the other type of treatment.
Conclusion:
In our experience, total in-hospital stay cost analysis did not reveal significant differences between ABFs and CKSs for AIOD revascularization. Further analysis are needed to validate our results, including a larger number of patients.