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World Journal of Surgery

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Open Access 01-11-2017 | Original Scientific Report

Cost-Effectiveness of Two Decision Strategies for Shunt Use During Carotid Endarterectomy

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

Published in: World Journal of Surgery | Issue 11/2017

Abstract

Background

Arterial 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.

Methods

Two 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.

Results

A 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.

Conclusions

Given 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.

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Title: Cost-Effectiveness of Two Decision Strategies for Shunt Use During Carotid Endarterectomy
Authors: Joe L. P. Kolkert
Rolf H. H. Groenwold
Vanessa J. Leijdekkers
Joep ter Haar
Clark J. Zeebregts
Anco Vahl
Publication date: 01-11-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 11/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4085-5

At a glance: The STEP trials

Springer Medicine

Cost-Effectiveness of Two Decision Strategies for Shunt Use During Carotid Endarterectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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