Title

Outcome-based cost analysis of transfemoral transcatheter aortic valve aortic valve replacement using fascia iliaca compartment block and minimalist conscious sedation approach versus general anesthesia

Document Type

Article

Publication Date

3-2017

Abstract

Background: Early studies demonstrated feasibility of minimalist conscious sedation (CS) for Transfemoral (TF) access for transcatheter aortic valve replacement (TAVR). A recent STS-ACC TVT Registry analysis demonstrated that a CS TF-TAVR has lower mortality, stroke, and shorter length of stay (LOS) vs. general anesthesia (GA) TF TAVR. We recently reported that a novel anesthetic approach using a fasica iliaca compartment block (FICB) + CS for patients undergoing TF TAVR was associated with a shorter operating room time, shorter imaging time, lower incidence of blood transfusion, and shorter LOS as compare to GA. Whether these results can be used to further demonstrate a reduced cost of FICB + CS as compare to GA in patients undergoing TF TAVR is currently not known. Methods: Completed billing information in 65 consecutive patients who underwent balloon expandable TF-TAVR using GA or FICB + CS between the billing cycle of January 2013 and December 2015 were collected.

Results: Variables (mean ± S.D.) FICB + CS (N = 25) GA (N = 40) P-Value Age, years 83 ± 7.4 81 ± 8.9 0.2 Weight, kg 81.3 ± 20 79.2 ± 18 0.5 STS PROM Score, % 7.6 ± 6.6 7.7 ± 4.3 0.93 Anesthesia Cost, $ 1,126 ± 480 1,419 ± 731 0.09 Cardiology Cost, $ 565 ± 143 763 ± 298 0.003 Blood Transfusion Cost, $ 1,174 ± 561 935 ± 716 0.54 Imaging Cost, $ 194 ± 157 229 ± 188 0.44 Operating Room Cost, $ 891 ± 431 1,169 ± 471 0.02 ICU Cost, $ 1,612 ± 1,782 3,669 ± 4,778 0.04 Total Direct Cost, $ 47,264 ± 11,761 68,307 ± 25,185 <0.0001

Conclusions: The result of this study suggest that FICB + CS may be associated with lower cost than GA, due in part to lower cardiology cost, shorter time in the operating room, and shorter ICU LOS in patients undergoing balloon expandable TF TAVR.

Comments

American College of Cardiology (ACC) Conference, Washington, DC, March 19, 2017.

Share

COinS