Cost-Effectiveness of Two Decision Strategies for Shunt Use During Carotid EndarterectomyReportar como inadecuado

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World Journal of Surgery

pp 1–9

First Online: 16 June 2017DOI: 10.1007-s00268-017-4085-5

Cite this article as: Kolkert, J.L.P., Groenwold, R.H.H., Leijdekkers, V.J. et al. World J Surg 2017. doi:10.1007-s00268-017-4085-5


BackgroundArterial shunting during carotid endarterectomy CEA is essential in some patients because of insufficient cerebral perfusion during cross-clamping. However, the optimal diagnostic modality identifying these patients is still debated. None of the currently used modalities has been proved superior to another. The aim of this study was to assess the cost-effectiveness of two modalities, stump pressure measurement SPM versus electroencephalography EEG combined with transcranial Doppler TCD during CEA.

MethodsTwo retrospective cohorts of consecutive patients undergoing CEA with different intraoperative neuromonitoring strategies SPM vs. EEG-TCD were analyzed. Clinical data were collected from patient hospital records. Primary clinical outcome was in-hospital stroke or death. Total admission costs were calculated based on volumes of healthcare resources. Analyses of effects and costs were adjusted for clinical differences between patients by means of a propensity score, and cost-effectiveness was estimated.

ResultsA total of 503 239 SPM; 264 EEG-TCD patients were included, of whom 19 sustained a stroke or died during admission 3.3 vs. 4.2%, respectively, adjusted risk difference 1.3% 95% CI −2.3–4.8%. Median total costs were €4946 IQR 4424–6173 in the SPM group versus €7447 IQR 6890–8675 in the EEG-TCD group. Costs for neurophysiologic assessments were the main determinant for the difference.

ConclusionsGiven the evidence provided by this small retrospective study, SPM would be the favored strategy for intraoperative neuromonitoring if cost-effectiveness was taken into account when deciding which strategy to adopt.

Autor: Joe L. P. Kolkert - Rolf H. H. Groenwold - Vanessa J. Leijdekkers - Joep ter Haar - Clark J. Zeebregts - Anco Vahl


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