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Is Varicose Veins Surgery “Profitable” in Hospitals?
Vol. 29, No. 6, August 2015 30th Annual Meeting, French Society for Vascular Surgery (SCV), Montpellier, France, June 27-29, 2015 1065
formation by the organization of specific workshops; but the new regulations of the French Medical Association do not encourage this form of initiative. The offer of formation should answer the recent evolutions of our specialty, under the aegis of the French College of vascular surgery (CFCV), of the French Society for Vascular Surgery (SCV) and of the sub-section 51-04 of the National Council of Universities (CNU). http://dx.doi.org/10.1016/j.avsg.2015.06.048
interventions. Our measured costs are lower than the results of the ENCC, in spite of important staff costs. There is no medico-economic justification for unilateral surgery only. Endovenous obliteration by radio frequency remains compatible with the tariffs, although the operative duration is not significantly different from conventional surgery. An improvement of the productivity could currently be obtained by the development of local anesthesia which classifies only for radiofrequency, and by the limitation of the number of personnel in the operating room. http://dx.doi.org/10.1016/j.avsg.2015.06.047
Is Varicose Veins Surgery ‘‘Profitable’’ in Hospitals? Jacques Chevalier, Remi Laurent, Nicolas Delhaye, Mehdi Touil, Matthieu Delloye, Ambre Bohnert, Beatrice Sarraz-Bournet, Vincent Tremion, and Gerard Forzy Groupement des H^opitaux de l’Institut Catholique de Lille, Service de chirurgie vasculaire, Centre Hospitalier Saint Philibert, Lomme, France. Objectives: According to the ‘‘Base of Knowledge’’ published by the High French Authority and the National Support Agency for the Performance of Health and MedicoSocial Facilities, the hospital tariffs (T2A) of the varicose veins surgery were 1280V in 2011 for a cost measured by the National Study of Costs with Common Methodology (ENCC) of 1664V in ambulatory surgery, that is to say a loss of 380 V per stay. We wished to compare tariffs and costs within our non-lucrative hospital in order to check if this operation was economically balanced. Materials and Methods: We collected during a four months period the costs of the interventions of venous surgery carried out. These costs were composed of costs of housing (programming, hospitalization and nursing care, billing), costs of structure, costs of operating room suite and personnel (surgeon, anesthetist, nurses, resident), and in material (operative material, surgical drapes and blouses, wire, stripper or radio frequency probes). These costs were then compared with the hospital tariff of ambulatory surgery for varicose veins which was 1319V in 2014. Results: Between September 2014 and December 2014, 95 patients were operated for superficial venous surgery in our service, of which 36 were operated on both sides. The techniques used were crossectomy and stripping with phlebectomies (N¼36), phlebectomies with or without peroperative echo-sclerosis (N¼22), and endovenous obliteration by radio-frequency with phlebectomies (N¼37). The mean duration of operating room occupation was 89 min, and the measured costs were on average 918V (4951475). Only four patients had costs higher than the tariff. Interventions using radio frequency were more expensive by 313V (p¼10-7), and bilateral interventions were more expensive than the unilateral ones by 106V (p¼0.02). Conclusion: Our calculations were made by patient and not by leg, the tariff being identical for bilateral
Is it Possible to Apply a Conservative Strategy of the Greater Saphenous Vein in patients with an Open Varicose Ulcer? Paul Pittaluga, and Sylvain Chastanet Riviera Veine Institut, Monaco.
Objectives: In the presence of an open varicose ulcer (CEAP Class C6) the treatment of the venous insufficiency is usually extensive to eliminate the reflux. We wanted to know if it was possible to preserve the greater saphenous vein (GSV) in this context. Materials and Methods: We re-examined all the interventions carried out in our institution during the last ten years in patients who presented varices with an insufficiency of the GSV. We excluded the cases with an association of arteriopathy and major venous insufficiency. Results: A total of 6125 surgical operations were reexamined. The distribution of the class C of the CEAP was the following one: CO-C1¼0, C2¼4989 (81.5%), C3¼554 (9%), C4¼423 (6.9%), C5¼81 (1.3%), C6¼78 (1.3%). Among the 78 interventions carried out in patients who presented a C6 stage, a stripping or a thermal endovenous ablation was realized in 45 cases (group 1:57.7%) and a preservation of the saphenous vein according to the principles of the method of Selective Ablation of the Varices under Local Anesthesia (ASVAL) in 33 cases (group 2: 42.3%). All the patients daily wore elastic stocking with a 32 mmHg compression until the healing of the ulcer. The reflux in the greater saphenous vein was more often limited to the thigh in group 2 (72.7% vs. 13.3% P¼0.01) and the ostial valve was more often continent (18.2% vs. 100% P<0.01). All the ulcers healed in the two groups and the average time of healing and the rate of recurrence of the ulcer were similar in the two groups (73.5 vs. 66.1 days, P¼0.38 and 6.6% vs. 9.1%, P¼0.69, respectively). Conclusion: In the presence of an open varicose ulcer a strategy of conservation of the GSV can be considered with results equivalent to those of a stripping or a thermal ablation of the GSV for the evolution of the ulcer, in selected
formation by the organization of specific workshops; but the new regulations of the French Medical Association do not encourage this form of initiative. The offer of formation should answer the recent evolutions of our specialty, under the aegis of the French College of vascular surgery (CFCV), of the French Society for Vascular Surgery (SCV) and of the sub-section 51-04 of the National Council of Universities (CNU). http://dx.doi.org/10.1016/j.avsg.2015.06.048
interventions. Our measured costs are lower than the results of the ENCC, in spite of important staff costs. There is no medico-economic justification for unilateral surgery only. Endovenous obliteration by radio frequency remains compatible with the tariffs, although the operative duration is not significantly different from conventional surgery. An improvement of the productivity could currently be obtained by the development of local anesthesia which classifies only for radiofrequency, and by the limitation of the number of personnel in the operating room. http://dx.doi.org/10.1016/j.avsg.2015.06.047
Is Varicose Veins Surgery ‘‘Profitable’’ in Hospitals? Jacques Chevalier, Remi Laurent, Nicolas Delhaye, Mehdi Touil, Matthieu Delloye, Ambre Bohnert, Beatrice Sarraz-Bournet, Vincent Tremion, and Gerard Forzy Groupement des H^opitaux de l’Institut Catholique de Lille, Service de chirurgie vasculaire, Centre Hospitalier Saint Philibert, Lomme, France. Objectives: According to the ‘‘Base of Knowledge’’ published by the High French Authority and the National Support Agency for the Performance of Health and MedicoSocial Facilities, the hospital tariffs (T2A) of the varicose veins surgery were 1280V in 2011 for a cost measured by the National Study of Costs with Common Methodology (ENCC) of 1664V in ambulatory surgery, that is to say a loss of 380 V per stay. We wished to compare tariffs and costs within our non-lucrative hospital in order to check if this operation was economically balanced. Materials and Methods: We collected during a four months period the costs of the interventions of venous surgery carried out. These costs were composed of costs of housing (programming, hospitalization and nursing care, billing), costs of structure, costs of operating room suite and personnel (surgeon, anesthetist, nurses, resident), and in material (operative material, surgical drapes and blouses, wire, stripper or radio frequency probes). These costs were then compared with the hospital tariff of ambulatory surgery for varicose veins which was 1319V in 2014. Results: Between September 2014 and December 2014, 95 patients were operated for superficial venous surgery in our service, of which 36 were operated on both sides. The techniques used were crossectomy and stripping with phlebectomies (N¼36), phlebectomies with or without peroperative echo-sclerosis (N¼22), and endovenous obliteration by radio-frequency with phlebectomies (N¼37). The mean duration of operating room occupation was 89 min, and the measured costs were on average 918V (4951475). Only four patients had costs higher than the tariff. Interventions using radio frequency were more expensive by 313V (p¼10-7), and bilateral interventions were more expensive than the unilateral ones by 106V (p¼0.02). Conclusion: Our calculations were made by patient and not by leg, the tariff being identical for bilateral
Is it Possible to Apply a Conservative Strategy of the Greater Saphenous Vein in patients with an Open Varicose Ulcer? Paul Pittaluga, and Sylvain Chastanet Riviera Veine Institut, Monaco.
Objectives: In the presence of an open varicose ulcer (CEAP Class C6) the treatment of the venous insufficiency is usually extensive to eliminate the reflux. We wanted to know if it was possible to preserve the greater saphenous vein (GSV) in this context. Materials and Methods: We re-examined all the interventions carried out in our institution during the last ten years in patients who presented varices with an insufficiency of the GSV. We excluded the cases with an association of arteriopathy and major venous insufficiency. Results: A total of 6125 surgical operations were reexamined. The distribution of the class C of the CEAP was the following one: CO-C1¼0, C2¼4989 (81.5%), C3¼554 (9%), C4¼423 (6.9%), C5¼81 (1.3%), C6¼78 (1.3%). Among the 78 interventions carried out in patients who presented a C6 stage, a stripping or a thermal endovenous ablation was realized in 45 cases (group 1:57.7%) and a preservation of the saphenous vein according to the principles of the method of Selective Ablation of the Varices under Local Anesthesia (ASVAL) in 33 cases (group 2: 42.3%). All the patients daily wore elastic stocking with a 32 mmHg compression until the healing of the ulcer. The reflux in the greater saphenous vein was more often limited to the thigh in group 2 (72.7% vs. 13.3% P¼0.01) and the ostial valve was more often continent (18.2% vs. 100% P<0.01). All the ulcers healed in the two groups and the average time of healing and the rate of recurrence of the ulcer were similar in the two groups (73.5 vs. 66.1 days, P¼0.38 and 6.6% vs. 9.1%, P¼0.69, respectively). Conclusion: In the presence of an open varicose ulcer a strategy of conservation of the GSV can be considered with results equivalent to those of a stripping or a thermal ablation of the GSV for the evolution of the ulcer, in selected