More and more in our daily lives, we see a push to make things more cost-effective. There are legitimate ways to cut costs, however, I really have trouble seeing any huge gains earned by the hospital when you eliminate anesthesiologists and/or surgeons. People need to look at risk assessment in these cases. What if an already sick patient decompensates during the procedure? Is the cost-effective strategy of eliminating caregivers really the best way to save money? It seems to me that liability would be a greater risk without having a surgeon for a crash sternotomy or an anesthesiologist to manage the airway and physiology.
There is global debate how to make TAVR procedures less expensive. Some sites changed from general anesthesia to sedation, some go even beyond that and keep patients fully awake during the procedure. Some sites eliminated anesthesiologists, some even eliminated the surgeons, as well. All this in the name of cost reduction, in exchange of safety, comfort and crucial information if not selected properly. TEE requires general anesthesia, but it can provide invaluable information and we anesthesiologists, can provide tailored and safe anesthesia. In certain situations, like severe lung disease, in experienced hands, sedation could be more appropriate than general anesthesia, even if it means eliminating TEE.
We looked at the cost of TAVR not just as a procedural cost, but as a post-procedural cost. Renal failure following TAVR can occur with underlying renal insufficiency and has significant financial and quality of life consequences. One of the mechanisms for this serious…
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