IYSC12 - Economic Impact of Transperitoneal versus Retroperitoneal Approach in Elective Infrarrenal Abdominal Aortic Aneurysm Open Repair: A Resource Consumption Analysis

Objectives: Vascular surgery has been directed toward endovascular approaches; however, not all patients qualify for these procedures. Abdominal Aortic Aneurysm Open Repair (AAOR) is crucial for specific clinical scenarios and complex cases. As healthcare systems worldwide strive for cost efficiency without compromising patient outcomes, evaluating the economic impact of these surgical approaches is imperative. This study aims to assess and compare the resource consumption and associated costs of transperitoneal versus retroperitoneal surgical in elective infrarrenal AAOR methods to inform decision-making and optimize resource allocation in healthcare settings.

Methods: A retrospective analysis was performed on patient cohorts undergoing transperitoneal (n=131) and retroperitoneal (n=384) surgical approaches. Quantitative variables included ICU stay (days), hospital stay (days), and surgery duration (minutes). Qualitative variables comprised wound infection and intraoperative reinterventions. Cost calculations utilized ICU bed day ($2,880.90), medium care bed day ($2,054.80), operating room per hour ($1,247.40), and total wound infection cost ($18,903.50). Statistical analyses employed independent t-tests or Mann-Whitney U tests for quantitative data and chi-square tests for qualitative data, with a significance level set at α = 0.05.

Results: The transperitoneal group demonstrated significantly higher resource consumption. The average ICU stay was 4.10 days ($11,803) versus 2.69 days ($7,753) for the retroperitoneal group. Hospital stays averaged 12.47 days ($25,610) compared to 8.36 days ($17,148) respectively. Surgical duration was longer in the transperitoneal approach, averaging 182.44 minutes ($3,794) compared to 156.81 minutes ($3,261). The incidence of wound infection was significantly higher in the transperitoneal group (3.83% vs. 2.60%, p=0.000), as were intraoperative reinterventions (16.80% vs. 7.29%, p=0.002). The total cost per patient was $42,138 for transperitoneal versus $28,744 for retroperitoneal approaches, reflecting an incremental cost of $13,394 per patient for the transperitoneal method.

Conclusions: The transperitoneal surgical approach is associated with higher healthcare resource utilization and increased costs than the retroperitoneal approach. Longer ICU and hospital stays, extended surgical durations, and higher rates of complications and reinterventions drive these differences. Optimizing transperitoneal protocols and reducing complication rates could mitigate these economic burdens. This study highlights the necessity of cost evaluations in surgical decision-making to enhance healthcare efficiency and sustainability while maintaining clinical efficacy.