Peripheral Vascular Surgery Society

#3 COST EFFECTIVE AORTIC EXPOSURE: A RETROPERITONEAL EXPERIENCE.

Jeffrey L. Ballard, MD and J. David Killeen, MD
Loma Linda University Medical Center, Loma Linda, CA.

Hypothesis: That the surgical approach to infrarenal aortic aneurysm (IAA) repair significantly affects in-hospital morbidity and cost.

Study Design: Consecutive series of 96 patients with elective repair of an IAA by two vascular surgeons using an established protocol from 3/95 to 3/99. This study compares 50 patients with transperitoneal (TP) exposure to 46 patients with retroperitoneal (RP) exposure.

Setting: University hospital, tertiary care center.

Main Outcome Measures: Hospital and ICU days, perioperative complications and cost.

Results: All patients followed the same protocol except for intraoperative aortic exposure. Preoperative carotid and cardiac screening, intraoperative use of a Swan Ganz catheter, mannitol 12.5 gm bolus before aortic cross clamping, low dose dopamine, judicious use of postoperative fluids and preadmission patient education regarding early ICU and hospital discharge was accomplished in all patients.

There was no significant difference between TP and RP groups with regard to demographic features (all p values >0.30), mean IAA size (p=0.41), or mean operative blood loss (p=0.89). Incidence of postoperative complications was similar between the groups (11 in TP and 6 in RP; p=0.25). However, a trend without statistical significance was noted in the incidence of pulmonary complications (7 in TP and 2 in RP; p=0.10). Mean ICU days (4 vs. 2; p=0.004) and hospital days (10 vs. 6; p=0.005) were significantly longer for TP aortic exposure compared to the RP approach. There was one (1%) perioperative death in the TP group and four (4%) late deaths in the series (mean follow-up; 17 months). Three of these were in TP group and one was in the RP group (p=0.62). Mean total hospital cost was significantly reduced for patients having RP IAA repair compared to TP IAA repair, primarily due to decreased ICU and hospital days (mean cost difference = $4,659; p=0.016).

Conclusions: Retroperitoneal exposure for IAA repair is associated with decreased pulmonary complications, significantly shorter ICU and hospital days and significantly decreased hospital cost compared to transperitoneal aortic exposure. This suggests that in the future, RP exposure for IAA repair should be the benchmark for comparison of any new techniques.

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Last Updated 5/28/99