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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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 .

Anahtar Kelimeler

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

Kaynakça

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