Open AccessCost‐Effectiveness of Two Decision Strategies for Shunt Use During Carotid Endarterectomy
Author(s) -
Kolkert Joe L. P.,
Groenwold Rolf H. H.,
Leijdekkers Vanessa J.,
Haar Joep,
Zeebregts Clark J.,
Vahl Anco
Publication year - 2017
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-017-4085-5
Subject(s) - medicine , carotid endarterectomy , vascular surgery , retrospective cohort study , stroke (engine) , transcranial doppler , emergency medicine , endarterectomy , intraoperative neurophysiological monitoring , abdominal surgery , anesthesia , surgery , radiology , cardiac surgery , carotid arteries , mechanical engineering , engineering
Background Arterial shunting during carotid endarterectomy (CEA) is essential in some patients because of insufficient cerebral perfusion during cross‐clamping. However, the optimal diagnostic modality identifying these patients is still debated. None of the currently used modalities has been proved superior to another. The aim of this study was to assess the cost‐effectiveness of two modalities, stump pressure measurement (SPM) versus electroencephalography (EEG) combined with transcranial Doppler (TCD) during CEA. Methods Two retrospective cohorts of consecutive patients undergoing CEA with different intraoperative neuromonitoring strategies (SPM vs. EEG/TCD) were analyzed. Clinical data were collected from patient hospital records. Primary clinical outcome was in‐hospital stroke or death. Total admission costs were calculated based on volumes of healthcare resources. Analyses of effects and costs were adjusted for clinical differences between patients by means of a propensity score, and cost‐effectiveness was estimated. Results A total of 503 (239 SPM; 264 EEG/TCD) patients were included, of whom 19 sustained a stroke or died during admission (3.3 vs. 4.2%, respectively, adjusted risk difference 1.3% (95% CI −2.3–4.8%)). Median total costs were €4946 (IQR 4424–6173) in the SPM group versus €7447 (IQR 6890–8675) in the EEG/TCD group. Costs for neurophysiologic assessments were the main determinant for the difference. Conclusions Given the evidence provided by this small retrospective study, SPM would be the favored strategy for intraoperative neuromonitoring if cost‐effectiveness was taken into account when deciding which strategy to adopt.