Subfascial Endoscopic Perforator Surgery Conserves Hospital Resources

Abstract

Innovations in the management of venous disorders have included subfascial endoscopic perforator surgery (SEPS). Information on resource utilization of this procedure is limited. Comparison of sequential cohorts of patients treated for leg venous hypertension by SEPS versus open perforating vein ligation (OPL) was performed to quantify the impact on hospital resource utilization and length of stay. At the Jobst Vascular Center, the last OPL was performed in June 1995 and the first SEPS was performed in January 1994. The authors compared the last 34 consecutive OPL procedures with the first 33 consecutive SEPS operations. Both groups had similar clinical indications. Variables describing utilization of hospital resources were assessed from a computer database compiled at time of treatment and compared by use of t test and chi-square statistics. Charges were selected as representation of hospital resources. SEPS length of stay, 2.3 ±1.8 (sd) days was significantly less than OPL, 4.5 ±2.7 days (p < 0.001) with concomitant reduction in physician bedside visits, 4.8 ±3.9 for SEPS versus 8.0 ±5.3 for OPL (p = 0.007). Total hospital charges in dollars, adjusted for sequential annual increments, were similar: 8,093 +3,811 for OPL versus 7,278 ±1,716 for SEPS (p=0.27). When OPL and SEPS were compared respectively, there were no significant differences in patient age, 58 ±14 versus 53 ±12 years; gender distribution, 62% women versus 42%; active ulcer status, 88% versus 85%; advanced admission testing, 41% versus 58%; use of venography, 97% versus 88%; use of general anesthesia, both 82%; or concomitant vein stripping, 65% versus 58% (p >0.1). SEPS anesthesia time was longer, 136 ±10 versus 122 ±28 minutes (p = 0.01), but not clinically significant. SEPS reduced length of hospital stay and number of physician bedside visits compared with OPL. Total hospital charges may be further reduced as experience with this procedure accumulates.