Comparison of cost affecting parameters and costs of the 'closed' and 'open' in situ bypass technique

Objectives: The 'closed' in situ bypass results in a reduction of wound complications compared to the 'open' technique. This advantage is partly diminished by extra costs for the 'closed' procedure and a larger percentage of residual arteriovenous (AV)-fistulae. This aim of this study was to analyse costs related to 'closed' and 'open' procedures. Methods: The cost affecting parameters: (1) duration of operation; (2) length of hospital stay; and (3) number of treated residual AV-fistulae, were analysed in a randomised group of 73 patients (35 'closed' and 38 'open') in two centres. In addition, costs of the operation, nursing care and treatment of AV-fistulae were analysed. Results: The 'closed' and 'open' group showed a median duration of operation of 210 min (range 105-570) and 154 min (range 90-355) (p < 0.05), length of hospital stay of 16 days (range 5-51) and 25 days (range 12-65) (p < 0.01), and a percentage of patients treated for residual AV-fistulae of 40% and 5%, respectively (p < 0.01). The median 'closed' operation was US$ 798 more expensive than the 'open'. Median postoperative care was US$ 2664 less for the 'closed' group. Mean estimated costs for treatment of AV-fistulae was US$ 9 in the 'open' and US$ 167 in the 'closed' group. Conclusion: The 'closed' in situ vein bypass technique is cost-effective in comparison with the 'open' technique.

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