Cost:Benefit Analysis of Elective Retroperitoneal Aortic Bypass

Abstract

Of 72 consecutive patients needing abdominal aortic surgery, the transperi toneal approach (TA) was used in 34 patients. In this TA group, with a mean age of fifty-eight years, 28 patients had aortoiliac or aortobifemoral grafts. Of the 38 patients operated via the retroperitoneal approach (RA), 27 had aortoiliac disease and 11 had aneurysms. In the RA group, the mean age was fifty-nine years; 32 patients in this group had aortofemoral grafts. The groups were simi lar with regard to hypertension, heart disease, obstructive pulmonary disease, previous myocardial infarction, and stroke.

The TA was associated with the larger intraoperative blood loss (1,100 mL) when compared with the RA (mean: 400 mL). Intraoperative crystalloid re quirements were significantly higher for the TA (5,500 mL) versus the RA (3,000 mL). Similarly, the intraoperative blood requirements were higher for the TA (3.0 units packed red blood cells [PRBC]) than the RA (1.0 unit PRBC). The numbers of units of PRBC transfused after surgery were significantly less with the RA (1.25 units) compared with the TA (0.5 unit). The total operative time for the TA was 225 minutes; the time for the RA was 165 minutes (p < 0.01).

The number of hospitalized postoperative days in the TA was 11.5 compared with 6 days in the RA; average number of days of nasogastric intubation was 4 days for the TA compared to 0.25 day for the RA; and tolerance for regular food was initiated at 5.5 days in the TA compared with 1.5 days in the RA. The number of hours of postoperative intubation for the TA was an average of 19.5 compared with 4.5 for the RA; the number of postoperative verbal orders in the TA was 14.0 compared with 4.5 in the RA; and complications in the TA were six times greater than in the RA. Most of the TA complications were pulmonary; these were not present in the RA. The incidence of wound infection was zero in both groups; mortality was zero in both groups. The average hospital cost of the TA was $20,125.26 compared with $5,164.05 for the RA. The RA for abdominal aortic vascular surgery is more cost effective than the TA.