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Retroperitoneal approach for aortic surgery: is it worth it?
F R Arko1, W T Bohannon, M Mettauer
1Division of Vascular Surgery, Texas A&M University Health Science Center, Scott & White Clinic, 2401 S 31st Street, TX 76508, Temple, USA.
Cardiovascular Surgery (London, England)
|January 4, 2001
Summary
The retroperitoneal approach for aortic surgery significantly reduces intensive care unit (ICU) time, postoperative ileus, and hospital costs compared to the transperitoneal approach. This method enhances patient recovery and satisfaction while improving the value of aortic surgery.
Area of Science:
- Vascular Surgery
- Surgical Approaches
- Health Economics
Background:
- Contrasting reports exist regarding the benefits of retroperitoneal versus transperitoneal approaches for aortic surgery.
- Earlier hospital discharges and reduced complications are suggested with the retroperitoneal method.
- This study aimed to compare the cost-efficiency and outcomes of both approaches at a single institution.
Purpose of the Study:
- To compare the retroperitoneal and transperitoneal approaches for aortic surgery.
- To determine the most cost-efficient method for aortic surgery while maintaining high standards of care.
- To evaluate clinical outcomes, patient satisfaction, and hospital costs.
Main Methods:
- A prospective vascular registry and retrospective review of 120 patients undergoing aortic surgery (60 transperitoneal, 60 retroperitoneal).
- Patients were randomly assigned to surgeons and followed a standardized clinical pathway.
- Data collected included demographics, comorbidities, operative details, length of stay, complications, costs, and patient satisfaction.
Main Results:
- No significant demographic differences; however, the retroperitoneal group had increased comorbidities (renal insufficiency, obesity) and included redo surgeries.
- The retroperitoneal group showed statistically significant reductions in ICU days, postoperative ileus, and total length of stay (P<0.0001).
- Substantial cost reductions (P<0.01) and improved patient recovery and satisfaction were observed in the retroperitoneal group, with fewer pulmonary complications.
Conclusions:
- The retroperitoneal approach facilitated adherence to a clinical pathway, leading to decreased ICU time, ileus, crystalloid use, and length of stay.
- The transperitoneal approach group experienced difficulties progressing on the clinical pathway.
- The retroperitoneal approach resulted in significant cost savings and enhanced the value of aortic surgery for patients and the institution.