Comparing Intra-Operative Quality of Care and Equipment Utilization Between the Hybrid OR and the Mobile C-Arm during Infra-Inguinal Endovascular Intervention
Andrew Tran, BS, Rajesh K. Malik, MD, Tareq M. Massimi, MD, Edward Y. Woo, MD, Steven D. Abramowitz, MD.
MedStar Washington Hospital Center, Washington, DC, USA.
Objective: Hybrid ORs have been advertised to increase efficiency and improve patient safety when compared to the traditional mobile C-Arm. We sought to compare intra-operative quality of care and cost differences between Hybrid Operating Rooms and Mobile C-Arm systems during infra-inguinal endovascular intervention. Methods: A prospectively maintained retrospective database of infra-inguinal endovascular procedures performed at a single institution by 4 attending vascular surgeons from June 2014 to June 2016 was used. All cases were performed in either the hybrid OR or the designated vascular OR using a mobile C-arm. Cohorts were created based on the anatomic distribution of disease and by the type of procedure performed. Evaluated variables included fluoroscopy time, contrast use, procedure time and total OR time. Intra-operative endovascular equipment utilization was also recorded. Wilcoxon Rank-Sum test was performed on each cohort to compare each variable between the hybrid OR and the C-Arm OR to correct for non-parametric data. Results: There were statistically significant differences in both contrast utilization and fluoroscopy time while performing procedures in the hybrid suite when compared to the traditional OR. There was a 12% increase in wire, catheter and sheath utilization in the C-arm room when compared to the hybrid OR regardless of anatomic location of disease being treated. Overall, procedures treating SFA/Popliteal lesions using the C-arm had a statistically significant higher contrast volume (27.41 mL) used (p = 0.0073). A statistically significant difference in contrast volume was also found in treating tibial disease, where the estimated contrast volume of procedures performed using the mobile C-Arm was 28.04 mL higher than those performed using the fixed system (p = 0.0358). In treating SFA/popliteal lesions, procedures performed in the C-Arm room had a statistically significant higher fluoroscopy time by 427.11 sec (p = 0.0081). Although there was a higher average fluoroscopy time in the C-Arm room for tibial procedures (+213.12 sec), it was not found to be statistically significant (p = 0.3097). There was no difference in procedure time and total operating room time.Conclusion: Performing simple single-level infra-inguinal endovascular procedures in a hybrid suite may provide potential quality of care benefits to patients being treated. There may also be less equipment utilization conferring cost savings.
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