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TCAR In Community Hospitals: How Hybrid Rooms Stack Up Against The Traditional Operating Room
David Galel, MD, Andrew Ku, MD, Ramsey Elsayed, MD MS, Brian Tiu, MD, Amit Karmur, MD, Bolaji Nafiu, MD, Xiujie Wang, MD, Yara Gorski, MD.
Southwest Healthcare, Temecula, CA, USA.
OBJECTIVES: Transcarotid artery revascularization (TCAR) requires intra-operative fluoroscopy guidance and can be completed either in a hybrid operating room (HOR) equipped with advanced imaging capabilities, or in a traditional operating room (OR) with a mobile C-arm, which may be more commonly utilized in resource-limited institutions. We compared operative metrics between the two settings in community hospitals.
METHODS: Data was evaluated retrospectively from two regional community-based hospitals from 2019-2025. One hospital utilized a HOR and the other an OR with C-arm fluoroscopy. Procedures performed by surgeons operating in both facilities were included. TCARs that were aborted or converted to open endarterectomies were excluded. Metrics included skin-to-skin time, flow reversal time, fluoroscopy time, and contrast volume used. Analysis included two-tailed Mann-Whitney and one-way ANOVA tests using Microsoft Excel with significance determined at p<.05.
RESULTS: Data included 159 cases (HOR n=123, OR n=36) completed by five surgeons. Patients were 65% male, 64% over 75 years old, and 41% symptomatic. Patient comorbidities included angina (n=6, 4%), CHF (n=2, 1%), COPD (n=4, 3%), and ESRD (n=1, 1%). Compared with OR cases, HOR cases had shorter skin-to-skin times (61.5 vs. 83.5 min, p=.041), flow reversal times (10.5 vs. 12.3 min, p<.001), fluoroscopy times (7.9 vs. 9.5 min, p<.001), and lower contrast volume (41.5 vs. 49.8 cc, p=.002). Surgeon-specific variability was observed within both hospitals.
CONCLUSIONS: TCARs performed in a HOR was associated with reduced operative time, flow reversal time, fluoroscopic time, and contrast volume used compared with OR using C-arm fluoroscopy. These findings suggest potential safety and cost advantages of HOR utilization, supporting investment even in resource-limited community hospitals.
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