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A cost-effectiveness analysis of standard versus endovascular abdominal aortic aneurysm repair.

https://arctichealth.org/en/permalink/ahliterature187245
Source
Can J Surg. 2002 Dec;45(6):420-4
Publication Type
Article
Date
Dec-2002
Author
Thomas L Forbes
Guy DeRose
Stewart Kribs
Kenneth A Harris
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont. Tom.Forbes@lhsc.on.ca
Source
Can J Surg. 2002 Dec;45(6):420-4
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - economics - surgery
Blood Vessel Prosthesis Implantation - economics
Cost-Benefit Analysis
Hospital Costs
Humans
Ontario
Retrospective Studies
Vascular Surgical Procedures - economics
Abstract
To compare endovascular and standard open repair of abdominal aortic aneurysms in terms of initial in-hospital costs and the costs of secondary interventions and surveillance.
A retrospective study.
A university-affiliated tertiary care medical centre.
Seven patients who underwent elective endovascular (EV) repair of an abdominal aortic aneurysm in 1998 and 31 patients anatomically suitable for endovascular repair who underwent standard (STAN) elective repair. Follow-up ranged from 2 to 14 months.
Elective repair of an abdominal aortic aneurysm with use of the standard technique or endovascular technology.
Costs common to both groups were not determined. Costs were determined for total hospital stay, preoperative or postoperative embolization, grafts, additional endovascular equipment, and follow-up computed tomography.
Groups were similar with respect to demographic data and aneurysm size (EV = 6.23 cm v. STAN = 6.05 cm). All patients were in American Society of Anesthesiologists class III or IV. Vanguar bifurcated grafts and extensions were used in the EV group. The total cost for both groups in Canadian dollars included: cost of stay (EV, 5.6 d, $2092.63 v. STAN, 10.7 d, $4449.19; p = 0.009); cost of embolization (EV, n = 3; $900/procedure); cost of follow-up CT (EV, 5.4 per patient; $450/CT); cost of grafts (EV = $8571.43, STAN = $374); additional radiologic equipment costs (EV = $1475). The mean total cost differed significantly between the 2 groups (EV = $14,967.63 v. STAN = $4823.19; p = 0.004). The additional cost associated with a reduction in hospital stay was calculated by determining the incremental cost-effectiveness ratio (ICER, difference in mean costs/difference in mean length of stay = $1604.51).
Endovascular repair continues to be more expensive than standard open repair determined according to procedural and follow-up costs. The technology is still in the developmental stage, but as it evolves and follow-up protocols are streamlined, it is hoped that there will be an eventual reduction in the costs associated with the endovascular procedure.
PubMed ID
12500916 View in PubMed
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National audit of the recent utilization of endovascular abdominal aortic aneurysm repair in Canada: 2003 to 2004.

https://arctichealth.org/en/permalink/ahliterature172815
Source
J Vasc Surg. 2005 Sep;42(3):410-4
Publication Type
Article
Date
Sep-2005
Author
Thomas L Forbes
D Kirk Lawlor
Guy Derose
Kenneth A Harris
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, Canada. Tom.Forbes@lhsc.on.ca
Source
J Vasc Surg. 2005 Sep;42(3):410-4
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - epidemiology - surgery
Blood Vessel Prosthesis Implantation - methods - utilization
Canada - epidemiology
Chi-Square Distribution
Female
Humans
Length of Stay - statistics & numerical data
Male
Outcome Assessment (Health Care) - statistics & numerical data
Postoperative Complications
Abstract
Worldwide, increasing proportions of aortic aneurysms are repaired electively via the endovascular route. The purpose of this study was to report the recent utilization of endovascular repair in Canada by reviewing a national administrative database.
The Canadian Institute for Health Information database (a collection of all acute care hospitalizations) was reviewed to identify patients who received nonemergent repair of an abdominal aortic aneurysm (AAA) between April 1, 2003 and March 31, 2004. During this 1-year period, differentiation between endovascular (EVAR) and open repair was possible using ICD-10-CA procedural codes in eight of ten provinces. Case volumes, patient age, length of hospitalization, and mortality were stratified by method of repair, province, and size and teaching status of hospitals.
In this 1-year period, 1996 patients in eight provinces (representing 72% of Canada's population) underwent open repair (n = 1818, 91.1%) or EVAR (n = 178, 8.9%) of a nonruptured AAA. National utilization rates were 8.4 and 0.8 per 100,000 population for open repair and EVAR. These rates were more constant for EVAR (0 to 1.3) then for open repair (4 to 18.3) when analyzed on a provincial basis. Mean patient age did not differ between EVAR and open repair (73.7 vs 71.9 years, P = 0.4) while mean length of stay (5.8 vs 11.9 days, P = 0.03) and in-hospital mortality (0.6% vs 4.6%, P = .025) were significantly lower for EVAR than for open repair. Most EVAR (96%) and more than half of open repairs (56%) were performed in academic teaching centers.
Although EVAR results in significant reductions in length of hospitalization and early mortality, it continues to be underutilized in Canada compared with other national reports involving administrative databases.
PubMed ID
16171580 View in PubMed
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Examination of the trend in Canada toward geographic centralization of aneurysm surgery during the endovascular era.

https://arctichealth.org/en/permalink/ahliterature171418
Source
Ann Vasc Surg. 2006 Jan;20(1):63-8
Publication Type
Article
Date
Jan-2006
Author
Thomas L Forbes
D Kirk Lawlor
Guy Derose
Kenneth A Harris
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada. tom.forbes@lhsc.on.ca
Source
Ann Vasc Surg. 2006 Jan;20(1):63-8
Date
Jan-2006
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - surgery
Atherectomy
Canada
Chi-Square Distribution
Health Care Costs
Hospitals, University
Humans
Referral and Consultation - trends
Residence Characteristics
Surgical Procedures, Elective - economics - trends
Time Factors
Vascular Surgical Procedures - economics - statistics & numerical data - trends
Abstract
Unlike in the United States, endovascular aneurysm repair (EVAR) has not been widely disseminated in Canada but has remained limited to large-volume vascular surgery units. Since the development of the endovascular program at our hospital, we have experienced a growth in our aneurysm practice and the area of referral. The purpose of this study was to compare the geographic referral area of our aneurysm practice between 1997 (prior to the introduction of EVAR) and 2003 (EVAR and open surgery). Our prospective database was reviewed to identify patients who underwent elective open aneurysm repair in 1997 and 2003 and those who underwent EVAR in 2003. Each patient's county of residence was identified, allowing for grouping of patients into one of four geographic regions (I-IV) increasingly more distant from our hospital. Proportions were compared with the chi(2) test. In 1997, 105 patients underwent open abdominal aortic aneurysm repair, with the majority of patients originating from the two regions in closest proximity to our hospital (I, 34%; II, 46%; III, 18%; IV, 2%). This contrasts with the 2003 EVAR group (n = 63), which had a higher proportion of patients referred from greater distances (I, 13%; II, 27%; III, 27%; IV, 33%) (p
PubMed ID
16374535 View in PubMed
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A screening program to identify risk factors for abdominal aortic aneurysms.

https://arctichealth.org/en/permalink/ahliterature169644
Source
Can J Surg. 2006 Apr;49(2):113-6
Publication Type
Article
Date
Apr-2006
Author
Marge B Lovell
Kenneth A Harris
Guy Derose
Thomas L Forbes
Marielle Fortier
Brenda Scott
Author Affiliation
Division of Vascular Surgery, University of Western Ontario, London, ON. marg.lovell@lhsc.on.ca
Source
Can J Surg. 2006 Apr;49(2):113-6
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - complications - epidemiology - ultrasonography
Carotid Artery Diseases - complications - ultrasonography
Follow-Up Studies
Humans
Incidence
Male
Mass Screening
Odds Ratio
Ontario - epidemiology
Prospective Studies
Risk factors
Ultrasonography, Doppler
Abstract
We aimed to explore the feasibility of a nurse-supervised aneurysm screening program to identify any independent risk factors for abdominal aortic aneurysm (AAA) formation in high-risk patients.
We conducted a prospective observational study of 90 male patients in a university- affiliated hospital in southern Ontario. The patients were prospectively evaluated and all underwent abdominal ultrasonography, with the main outcome measure being detection of an AAA.
AAAs were identified in 18 patients (20%) and had a mean diameter of 3.6 (range 2.8-6.0) cm. A separate analysis was performed to identify risk factors for the presence of an aneurysm. The presence of carotid artery disease proved to be the only statistically significant independent predictor of the presence of AAA (odds ratio 2.23, 95% confidence interval 1.76-2.56).
This study confirms the feasibility of a nurse-supervised AAA screening program, and on the basis of these results we recommend ultrasonographic screening for AAA in patients with a history of carotid artery disease.
Notes
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PubMed ID
16630422 View in PubMed
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The effect of patient transfer on outcomes after rupture of an abdominal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature164406
Source
Can J Surg. 2007 Feb;50(1):43-7
Publication Type
Article
Date
Feb-2007
Author
Heather Hames
Thomas L Forbes
Jeremy R Harris
D Kirk Lawlor
Guy DeRose
Kenneth A Harris
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre and the University of Western Ontario, London, Ontario, Canada.
Source
Can J Surg. 2007 Feb;50(1):43-7
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - mortality - surgery
Aortic Rupture - mortality - surgery
Female
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
Intensive Care - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Ontario - epidemiology
Patient Transfer - statistics & numerical data
Referral and Consultation - statistics & numerical data
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
Abstract
Centralization of vascular surgery services has resulted in patients being transferred longer distances for treatment of life-threatening conditions. The purpose of this study was to determine whether patient transfer adversely affects the survival of people with a ruptured abdominal aortic aneurysm (RAAA).
We performed a retrospective review of all patients undergoing attempted repair of an RAAA at our centre, over a recent 3.5-year period (August 2000-December 2003). Patients were divided into those presenting directly to our centre and those transferred from another hospital. The main outcome variable was in-hospital or 30-day mortality, with secondary variables including time to surgical treatment, mortality in the first 24 hours and length of hospitalization.
Eighty-one patients (73% men) underwent attempted open repair of an RAAA at our centre during this period. Twenty-four patients (29.6%) presented directly to our hospital, while 57 (70.4%) were transferred from another institution. The overall mortality rate was 53%. Although transferred patients took twice as long as direct patients to get to the operating room (6.3 v. 3.2 h, p=0.03), there was no difference in mortality between the 2 groups (50% v. 54%, p=ns). However, deaths of transferred patients were more likely to occur in the first 24 postoperative hours, compared with direct patients (40% v. 33%, p
Notes
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PubMed ID
17391616 View in PubMed
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Implementation of a successful endovascular surgical program in a non-teaching tertiary-care centre in Ontario.

https://arctichealth.org/en/permalink/ahliterature179150
Source
Can J Surg. 2004 Jun;47(3):182-8
Publication Type
Article
Date
Jun-2004
Author
Rod P N Willoughby
John A Fenton
Santosh R Pudupakkam
Robert A Greco
Evan W D Roberts
Guy DeRose
Stewart Kribs
Author Affiliation
Division of Vascular Surgery, Sudbury Regional Hospital, Sudbury, Ont. rwilloughby@hrsrh.on.ca
Source
Can J Surg. 2004 Jun;47(3):182-8
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aneurysm - surgery
Female
Financial Support
Humans
Industry
Male
Middle Aged
Models, organizational
Ontario
Outcome Assessment (Health Care)
Patient care team
Patient Selection
Preceptorship
Program Development
Program Evaluation
Stents
Surgery Department, Hospital - organization & administration
Vascular Surgical Procedures - education - organization & administration
Abstract
Endovascular surgical techniques have become an accepted standard of care for high-risk patients with abdominal aortic aneurysms and for certain patients with thoracic aortic pathology and peripheral arterial aneurysms. In Canada, endovascular surgery has been concentrated in tertiary-care academic teaching institutions. As the technology evolves and as expertise advances, the applicability of endovascular techniques will expand. With time, and as the demand for endovascular techniques rises, this expertise will increasingly need to be delivered by dedicated vascular surgical services in nonteaching institutions. The dissemination of endovascular surgical capabilities represent a unique challenge. We report the successful implementation of an endovascular surgical program in a tertiary-care nonteaching institution using a carefully planned preceptorship model. We review our initial 49 cases and discuss 6 factors important to the successful establishment of an endovascular surgical service: education, teamwork, strict selection of patients, use of a single stent-graft manufacturer, industry support and endovascular preceptorship. Our experience may be used as a model by other institutions in Canada.
Notes
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PubMed ID
15264380 View in PubMed
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Endograft treatment of ruptured abdominal aortic aneurysms using the Talent aortouniiliac system: an international multicenter study.

https://arctichealth.org/en/permalink/ahliterature168882
Source
J Vasc Surg. 2006 Jun;43(6):1111-1123; discussion 1123
Publication Type
Article
Date
Jun-2006
Author
Noud Peppelenbosch
Robert H Geelkerken
Chee Soong
Piergiorgio Cao
Oren K Steinmetz
Joep A W Teijink
Mauri Lepäntalo
Jan De Letter
Frank E G Vermassen
Guy DeRose
Erik Buskens
Jaap Buth
Author Affiliation
Catharina Hospital, University Medical Center, 5602 ZA Eindhoven, the Netherlands.
Source
J Vasc Surg. 2006 Jun;43(6):1111-1123; discussion 1123
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Aged
Aneurysm, Ruptured - mortality - surgery
Aortic Aneurysm, Abdominal - mortality - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - methods - mortality
Canada
Chi-Square Distribution
Europe
Female
Humans
Male
Postoperative Complications
Proportional Hazards Models
Prospective Studies
Statistics, nonparametric
Tomography, X-Ray Computed
Treatment Outcome
Abstract
To understand the potential of endovascular aneurysm repair (EVAR) in patients presenting with a ruptured abdominal aortic aneurysm (rAAA), the proportion in whom this procedure was applicable was assessed. Mortality and morbidity was also determined in patients treated with emergency EVAR (eEVAR) when anatomic and hemodynamic conditions allowed (ie, in the entire cohort with patients receiving endovascular and open repair combined). In addition, a comparison was made between the treatment group with eEVAR and open repair.
Between February 2003 and September 2004, 10 participating institutions enrolled a representative sample of 100 consecutive patients in whom eEVAR was considered. Patients in the New Endograft treatment in Ruptured abdominal aortic Aneurysm (ERA) trial were offered eEVAR or open repair in accordance with their clinical condition or anatomic configuration. Written informed consent was obtained from all patients or their legal representatives. The study included patients who were treated by stent-graft technique or by open surgery in the case of adverse anatomy for endoluminal stent-grafting or severe hemodynamic instability, or both. Data were collated in a centralized database for analysis. The study was sponsored and supported by Medtronic, and eEVAR was uniquely performed with a Talent aortouniiliac (AUI) system in all patients. Crude and adjusted 30-day or in-hospital and 3-month mortality rates were assessed for the entire group as a whole and the EVAR and open repair category separately. Complication rates were also assessed.
Stent-graft repair was performed in 49 patients and open surgery in 51. No significant differences were observed between these treatment groups with regard to comorbidity at presentation, hemodynamic instability, and the proportion of patients who could be assessed by preoperative computed tomography scanning. Patients with eEVAR more frequently demonstrated a suitable infrarenal neck for endovascular repair, a longer infrarenal neck, and suitable iliac arteries for access than patients with open repair. The primary reason to perform open aneurysm repair was an unfavorable configuration of the neck in 80% of the patients. In patients undergoing eEVAR, operative blood loss was less, intensive care admission time was shorter, and the duration of mechanical ventilation was shorter (P
PubMed ID
16765224 View in PubMed
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7 records – page 1 of 1.