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Cost effectiveness of regional anesthesia in carotid endarterectomy
M S Godin1, W H Bell, M Schwedler
1Department of Otolaryngology, University of California at San Diego, La Jolla.
Insights
Regional anesthesia (RA) is more cost-effective than general anesthesia (GA) for carotid endarterectomy (CEA). RA offers significant hospital cost savings with no increase in mortality or morbidity rates, making it a superior choice for CEA procedures.
Area of Science:
- Anesthesiology
- Vascular Surgery
- Health Economics
Background:
- Carotid endarterectomy (CEA) is a surgical procedure to remove plaque from carotid arteries.
- Anesthesia choice, general (GA) versus regional (RA), impacts patient outcomes and healthcare costs.
- Previous studies have not comprehensively compared the cost-effectiveness of GA and RA for CEA.
Purpose of the Study:
- To prospectively assess the safety, efficacy, and hospital costs of general anesthesia (GA) and regional anesthesia (RA) for carotid endarterectomy (CEA).
- To determine the cost-effectiveness of RA compared to GA in patients undergoing CEA.
Main Methods:
- A prospective study involving 100 patients undergoing CEA.
- Patients were divided into two groups: 50 receiving GA and 50 receiving RA.
- Hospital costs (excluding medications and lab tests), ICU days, and regular hospital days were compared between the two groups.
Main Results:
- Patients under GA had an average cost of $4547 (1.2 ICU days, 6.1 hospital days).
- Patients under RA had an average cost of $2067 (0.1 ICU days, 4.1 hospital days).
- RA resulted in average savings of $2480 per patient, with no significant increase in mortality or morbidity.
Conclusions:
- Regional anesthesia (RA) is superior to general anesthesia (GA) in terms of cost-effectiveness for carotid endarterectomy (CEA).
- RA significantly reduces hospital costs associated with CEA without compromising patient safety or outcomes.
- The findings support the wider adoption of RA for CEA procedures to improve healthcare efficiency.
Abstract:
The purpose of this prospective study was to assess safety, efficacy, and hospital costs (excluding medications) and laboratory tests related to general (GA) and regional anesthesia (RA) for carotid endarterectomy (CEA). One hundred patients underwent CEA; 50 received GA and 50 received RA. Thirty-eight men (eight diabetic) and 12 women (two diabetic), with an average age of 62.4 (47 to 79) years comprised the GA group; 35 men (six diabetic) and 15 women (one diabetic), with an average age of 64.1 (51 to 74) years comprised the RA group. Twenty-one patients (17 men, 4 women) in the GA and 24 patients (19 men, 5 women) in the RA group had hypertension. Every patient had some stigmata of cardiac disease. Patients receiving GA for CEA spent an average of 1.2 days in the surgical Intensive Care Unit (ICU) and 6.1 days in a regular hospital bed, for an average cost of $4547. The patients who underwent CEA under RA had an average of 0.1 ICU days and 4.1 regular hospital days, for a cost of $2067. RA saved $2480 per patient and $124,000 in our study group, with no increase in mortality or morbidity rates (P less than 0.001). RA is superior to GA in cost-effectiveness for patients undergoing CEA.