Opportunity Cost Comparison Of Venous Closures: Radiofrequency Ablation Vs. Venaseal
Mariya Kochubey, MD1, Rachel Dirks, Phd1, Misaki M. Kiguchi, MD, MBA, FACS2, Bianca Cutler, MSN, FNP-C2, Jaclyn Kliewer, BS1, Leigh Ann A. O'Banion, MD, FACS1.
1UCSF Fresno, Fresno, CA, USA, 2MedStar Washington Hospital Center, Washington DC, DC, USA.
Objective: Chronic venous insufficiency is a costly pathology affecting up to 30% of the US population. Prior studies have highlighted the substantial burden of resource utilization and work-loss costs associated with this disease, estimating upwards of 2 million workdays per year lost in the US alone. Endovenous closure has proven to substantially improve health-related quality of life. Despite the shift from inpatient to outpatient ablation procedures, these minimally invasive techniques can still lead to loss of working days and economic disability. The aim of this study is to compare time to return to work post-procedure between two techniques of superficial vein closure: ClosureFastTM radiofrequency ablation (RFA) and adhesive closure (VenaSealTM).Methods: A multi-institutional retrospective review of actively employed patients with CEAP 2-5 disease who underwent closure of their truncal veins from 2019-2020 was performed. Patients undergoing RFA were compared to those undergoing VenaSeal adhesive closure. Patients with active venous leg ulcers were excluded. The primary endpoint was time to return to work. Secondary endpoints included infection, thrombophlebitis, and post-procedural DVT. Multivariate linear regression analysis examined factors affecting time to return to work in the most predictive model. Statistical significance was defined a p value <0.05.Results: Seventy-six patients were included in the study cohort: 40 treated with RFA and 36 treated with VenaSeal ablation. The majority of patients in the cohort had CEAP 3 disease (51%). Patients undergoing RFA were more frequently male (55% vs 25%, p=0.008) and had a higher BMI (34 kg/m2vs 30 kg/m2, p=0.02). Significantly more patients undergoing VenaSeal had a history of DVT (19% vs 0%, p=0.003). Mean time to return to work was significantly shorter in the VenaSeal group than RFA (1.5±2.4 vs 2.5±1.6 days, p≤0.001). On multivariate analysis, treatment modality was the only significant factor in time to return to work (p=0.02). There were no post procedure DVT or infections. Thirteen patients (17%) developed post-procedure thrombophlebitis but did not differ between groups (p=0.08). Conclusion: ClosureFast and VenaSeal are both safe and effective treatments to eliminate truncal venous insufficiency. VenaSeal patients are able to return to work significantly faster compared to RFA, reducing the opportunity cost of missed workdays.
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