p narayan, a wong, i davies, a j bryan, p wilde, g j murphy does tevar provide a financial benefit...
TRANSCRIPT
![Page 1: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/1.jpg)
P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy
Does TEVAR provide a financial benefit for management of descending thoracic aortic
pathologies?
![Page 2: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/2.jpg)
Background Management of descending aortic pathology is a
complex and challenging area
Surgical management is indicated in specific situations
Endo-Vascular Surgical Repair [TEVAR] provides another important option
Aim To assess early and mid term outcomes of TEVAR
compared with surgical repair
To compare the financial implications of TEVAR and surgical management
![Page 3: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/3.jpg)
Methods Retrospective study
Time period: April 1996- February 2009
85 procedures
Surgical repair: 35
TEVAR: 49
Data accessed from computerised database –PATS System
and validated by case note reviews
Hospital costs calculated from NHS reference costs for staff time,
consumables, transfusion and length of stay.
![Page 4: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/4.jpg)
Statistical Analysis
Data tabulated as N(%) for categorical data and median (inter-
quartile range) for continuous data
Continuous variables analysed with Mann Whitney U test
Categorical variables analysed with Fisher’s exact test or Chi-
square
Kaplan-Meier estimates were used to compare re- intervention
and survival
![Page 5: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/5.jpg)
Trends in the Management of Descending Thoracic Aortic Pathology
![Page 6: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/6.jpg)
Patient CharacteristicsSurgery (n=35) TEVAR (n=49) P value
Age (years) 55.5(33-67.5) 57.5(40.25-72) 0.210
Male 29 (81%) 34 (69%) 0.245
Pre op Neurological dysfunction
1(2%) 2(4%) 0.625
Previous cardiac surgery 10(27%) 12(24%) 0.818
COAD 3(8%) 4(8%) 0.607
Pre-op Renal Impairment 2(5%) 6(12%) 0.270
Current Smoker 20(55%) 23(47%) 0.356
Marfan 1(2%) 3(6%) 0.432
Diabetes 1(2%) 1(2%) 0.683
Hypertension 19(53%) 23(47%) 0.595
EuroScore 10(7-10) 9(8-10) 0.562
Emergency 12 (33%) 21 (43%) 0.047
Critical Preoperative State 12 (34%) 16 (33%) 0.876
![Page 7: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/7.jpg)
Procedural Characteristics
Surgery TEVAR p value
Operative Sessions 2 (2.0-2.3) 1 (1-1) <0.0001
Aneurysm 19 (53%) 22 (45%) 0.473
Thoracoabdominal 7 (19%) 5 (10%) 0.148
Arch 5 (14%) 0 0.011
Dissection 10 (28%) 17(35%) 0.499
Acute 5 (14%) 16 (33%) 0.047
Chronic 5 (14%) 1 (2%) 0.047
Trauma 5 (14%) 7 (14%) 0.303
Other 2 (5%) 3 (6%) 0.707
RBC Transfusion 8(3-12) 0(0-3) <0.0001
Platelet Transfusion 2(0-3) 0(0-0) <0.0001
FFP Transfusion 2(0-8) 0(0-0) <0.0001
![Page 8: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/8.jpg)
In Hospital Clinical OutcomeSurgery (n=35) TEVAR(n=49) P value
Atrial Fibrillation 12(33%) 1(2%) <0.0001
Inotropic Support 17(47%) 1(2%) <0.001
Neurological Complication 9(25%) 6(12%) 0.244
Renal Complication 11(31%) 5(10%) 0.025
GI Complication 5(14%) 5(10%) 0.513
Chest Infection 9(25%) 1(2%) 0.001
ARDS 2(5%) 0(0%) 0.159
Re-intubation 5(14%) 3(6%) 0.253
Tracheostomy 8(22%) 2(4%) 0.020
ITU Stay 6(3-11) 1(1-4) <0.0001
Hospital Stay 16(9-26) 10(6-17) 0.022
In Hospital Death 7(20%) 3(6%) 0.03
![Page 9: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/9.jpg)
Hospitalisation Costs of EVAR versus Surgery
Cost Surgery (£) TEVAR(£) p value
Staff Costs 1836 (1836-2075) 1433 (1433-1433) <0.0001
Consumable/ Stent Costs 412 (216-696) 8000 (8000-10000) <0.0001
Procedure Cost 2468 (2260-3168) 9581 (9581-11581) <0.0001
Transfusion Costs 1327 (531-2124) 0 (0-531) <0.0001
ICU Costs 7200 (3600-13200) 2400 (1200-6000) <0.0001
Hospitalisation Cost 10400 (5238-22500) 5350 (3200-8150) 0.001
Total Cost 15045 (9299-27571) 16694 (13532-21729) 0.414
![Page 10: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/10.jpg)
Mid-term Follow-up
Surgery (n=35) TEVAR (n=49)
Reintervention 1 (3%) 9 (18%)
Death 11 (31%) 10(20%)
Death or Reintervention
11 (31%) 18 (37%)
![Page 11: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/11.jpg)
Mid-term Outcomes of TEVAR and Surgery for Diseases of the Descending Thoracic Aorta
Surgery
TEVAR
Surgery
TEVAR
Mortality Re-intervention
Log Rank p=0.002Log Rank p=0.901
![Page 12: P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?](https://reader035.vdocument.in/reader035/viewer/2022062516/56649e625503460f94b5de98/html5/thumbnails/12.jpg)
Conclusions
TEVAR is associated with superior short-term results
Mid term survival is similar to surgery
Re-intervention rate is significantly higher in TEVAR
Resource utilisation is similar in both groups for the primary procedure
Costs may prove to be higher in the TEVAR group with re-interventions