背景：髂动脉支架置入术在手术室（OR）和导管插入室（CL）进行。迄今为止,没有分析比较这些位置之间的资源利用率。
方法：回顾性分析单中心连续治疗的患者（n=105）。患者包括患有慢性，症状性髂动脉狭窄，最低卢瑟福分类（RC）为3，用支架治疗。排除标准是先前植入支架，急性缺血，或主要伴随程序。观察近期和两年的结果。患者人口统计学，围手术期细节，医生比林斯，并记录了医院费用。多变量回归用于调整患者和围手术期费用驱动因素的费用。
结果：在OR中进行了51次手术（49％），在CL中进行了54次手术（51％）。平均年龄为57岁，44%为女性。重症病例更常见于OR（RC≥4；42%vs.11%,P<0.001），并与总费用增加有关（P<0.01）。或手术更经常使用额外的支架（支架≥2；61%vs.46%,P=0.214),溶栓（12%vs.0%,P=0.011),削减方法(8%与0%,P=0.052),和全身麻醉(80%vs.0%,P<0.001）：这些都与成本增加有关（P<0.05）。多元回归后，地点不是手术室或总费用的预测指标,但与专业费用的增加有关.相同住院（5％）和出院后再干预（33％）没有因地点而异。
结论：OR与住院时间增加有关，更多的ICU入院，增加了总成本。然而,OR患者的疾病更严重，因此通常需要更积极的干预。在控制了这些差异之后，手术地点本身与成本增加无关，但由于双重提供者的收费，OR病例增加了专业费用。鉴于不同地点的临床结果相似，在CL中进行大多数支架置入或在OR中使用有意识的镇静似乎是合理的。
BACKGROUND: Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these locations.
METHODS: Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures. Immediate and two-year outcomes were observed. Patient demographics, perioperative details, physician billings, and hospital costs were recorded. Multivariable regression was used to adjust costs by patient and perioperative cost drivers.
RESULTS: Fifty-one procedures (49%) were performed in the OR and 54 (51%) in the CL. Mean age was 57, and 44% were female. Severe cases were more often performed in the OR (RC ≥ 4; 42% vs. 11%, P < 0.001) and were associated with increased total costs (P < 0.01). OR procedures more often utilized additional stents (stents ≥ 2; 61% vs. 46%, P = 0.214), thrombolysis (12% vs. 0%, P = 0.011), cut-down approach (8% vs. 0%, P = 0.052), and general anesthesia (80% vs. 0%, P < 0.001): these were all associated with increased costs (P < 0.05). After multivariable regression, location was not a predictor of procedure room or total costs but was associated with increased professional fees. Same-stay (5%) and post-discharge reintervention (33%) did not vary by location.
CONCLUSIONS: The OR was associated with increased length of stay, more ICU admissions, and increased total costs. However, OR patients had more severe disease and therefore often required more aggressive intervention. After controlling for these differences, procedure venue per se was not associated with increased costs, but OR cases incurred increased professional fees due to dual-provider charges. Given the similar clinical results between venues, it seems reasonable to perform most stenting in the CL or utilize conscious sedation in the OR.
