Siena and St George Vascular Institute Risk Scoring Systems in Predicting the Cost-Effectiveness of EVAR

Year 2020, , 209 - 218, 30.12.2020

Ali Ahmet Arıkan , Şadan Yavuz Kamil Turan Berki

https://doi.org/10.25279/sak.626809

Abstract

Objectives: Endovascular aneurysm repair (EVAR) is a
widely used modality in the treatment of abdominal aortic aneurysms (AAA).
Siena EVAR and St.George Vascular Institute (SGVI) scores are risk scores to
predict possible EVAR related reinterventions. This study was aimed to validate
the risk scores and compare the predictivity of the scoring systems for
hospital cost-effectiveness in our population.

Materials and Methods: 39 patients with unruptured
infrarenal AAA, including both elective and non-elective admissions which had a
follow-up period from at least 6 months are included in our study. Siena EVAR
score and SGVI score are calculated. The relation of the complications
(adjuncts at the index operation, reinterventions during follow up), costs
(index procedure and overall), aneurysm related mortality are compared among
the risk groups. 

Results: In our study, SGVI score had a predictivity
among high and low-risk groups involving reinterventions during follow up, cost
on index operation and mortality (P < 0.05). Siena EVAR score had no
significant predictivity (p > 0.05).

Conclusion: A high-risk value in SGVI score must warn
the surgeon to reassess the treatment option for AAA. If  EVAR is indicated the health care providers
and assurance system can count on a higher cost on index operation, a higher
risk of reintervention and mortality during long term follow up.

Keywords

Aortic Aneurysm, Abdominal; Endovascular Procedures, risk assesment, Health Care Costs, reoperation

EVAR'ın Maliyet Etkinliğini Öngörmede Siena ve St George Vascular Institute Risk Skorlama Sistemleri

Abstract

Amaç: Endovasküler anevrizma onarımı (EVAR), abdominal aort
anevrizmalarının (AAA) tedavisinde yaygın olarak kullanılan bir yöntemdir.
Siena EVAR ve St.George Vasküler Enstitüsü (SGVI) puanları, EVAR ile ilgili
olası müdahaleleri öngörmek için kullanılan risk puanlarıdır. Bu çalışmada,
risk skorlarını doğrulamak ve skorlama sistemlerinin popülasyonumuzda hastane
maliyet etkinliği için öngörülerini karşılaştırmak amaçlandı.

Gereç ve Yöntem: Çalışmamıza en az 6 ay takip süresine sahip
rüptüre olmayan infrarenal AAA'lı 39 hasta dahil edildi. Siena EVAR skoru ve
SGVI skoru hesaplandı. Risk grupları arasında komplikasyonların (ilk
operasyonundaki ek işlemler, takip sırasında girişim ihtiyacı), maliyet (ilk işlem
ve genel), anevrizmaya bağlı mortalite arasındaki ilişki karşılaştırıldı.

Bulgular: Çalışmamızda SGVI skoru yüksek riskli ve düşük
riskli grupları arasında, takip sırasında girişim ihtiyacı, ilk işlem maliyeti
ve mortalite açısından anlamlı fark bulundu (P ​​<0.05). Siena EVAR skorunun
anlamlı bir öngörücülüğü yoktu (p> 0.05).

Sonuç: SGVI skorundaki yüksek riskli bir değer, cerrahı AAA
için tedavi seçeneğini yeniden değerlendirmesi için uyarmalıdır. EVAR risk
gruplamasına göre, sağlık hizmeti sağlayıcıları ve sosyal güvence sistemi, ilk  işleminlerde daha yüksek bir maliyet ve uzun
süreli takip sırasında daha yüksek oranda yeniden girişim ihtiyacı  ve ölüm riskini hesaba katmalıdır .

Keywords

Aort Anevrizması, Abdominal; Endovasküler İşlemler, Risk değerlendirmesi, Sağlık masrafları, reoperasyon

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