Acta Chir Belg
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Randomized Controlled Trial Clinical Trial
Economic considerations for aortic surgery: retroperitoneal approach--is it worth it?
Planned reductions in reimbursement for all forms of vascular surgery dictate a need for the development of more cost efficient, yet quality oriented, treatment programs. We are faced with an increasingly older patient population with multiple comorbidities. In this environment it will become extremely difficult to accomplish aortic surgery in a way which will be profitable for our hospitals. More than 100,000 aortic surgeries are performed annually in the United States. Previous reports suggest that earlier hospital discharges and reduced postoperative complications occur when a retroperitoneal approach is used for aortic surgery. Other publications refute this concept. In an effort to determine the most cost efficient method for aortic surgery in our institution, while maintaining high standards of care and outcome, we compared the retroperitoneal approach to the conventional transperitoneal aortic operation. ⋯ Our clinical pathway and algorithm for aortic surgery was easily followed by those patients in the retroperitoneal approach group and resulted in decreases in ICU time, postoperative ileus, volume of intraoperative crystalloid and total length of stay. The patients in the transperitoneal group often failed to progress appropriately on the pathway. Reduced hospital costs associated with aortic surgery using the retroperitoneal approach has increased the profitability for this surgery in our institution by an average of $4000 per case and has increased the value (quality/cost) of this surgery to our patients and our institution. This was accomplished in an academic environment with surgical residency training where cost containment has historically been difficult.