Penn Heart and Vascular

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Tuesday, July 31, 2012

Wrist vs. Groin Access: A Penn Study on Cardiac Stenting Procedures

A great debate is happening and it has nothing to do with politics. Can wrist catheterization instead of groin catheterization in coronary angiograms and stenting procedures provide benefits for hospitals and patients? New research indicates wrist procedures may significantly reduce the risk of complications for patients and offer cost savings to hospitals.

Senior research analyst Matthew D. Mitchell, PhD, along with other analysts in the Center for Evidence-based Practice at Penn Medicine compared the findings from 14 previously published studies regarding the outcomes from cardiac stenting procedures using both methods of access. The combined findings were then put into a cost-benefit simulation model designed to estimate the average cost of care for these procedures. The results? Access through the wrist, as opposed to the groin approach, is more cost effective and reduces complications for patients.

General medical concerns about increases in procedure time and access failure in patients were also laid to rest in the study. The researchers found that the wrist approach took on average only one minute and 23 seconds longer than the groin approach.

Although the cost savings benefit may not be as substantial in sites with groin access complications or long wrist catheterization times, Craig A. Umscheid, MD, director of the Penn Medicine Center for Evidence-based Practice and a co-author of the study, still thinks that wrist access in cardiac stenting procedures is a good idea.

“Overall, our study demonstrated that the savings from reduced vascular complications outweighed the increased costs of longer procedure times and access failure associated with radial artery access by a large margin,” Dr. Umscheid said.

Researchers from the Perelman School of Medicine at the University of Pennsylvania, the University of Washington Medical Center, and the University of Pittsburgh School of Medicine participated in the study. The findings were published online in Circulation: Cardiovascular Quality and Outcomes. More information on this study can also be found in Penn Medicine's News and Publications.

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