AbstractObjective With the proliferation of different carotid interventions, there is a need to understand the costs and reimbursements for different procedures and what perioperative factors drive cost. Evaluate the charges and reimbursements for carotid endarterectomies and Transcervical Carotid Artery Revascularization (TCAR) across surgical and payer groups. Methods Single institution retrospective cohort study, from 1/1/2014 to 7/1/2025. Using Epic Systems reporting tools, procedural charges, reimbursements (hospital and professional), and patient characteristics were extracted. The US Bureau of Labor Statistics inflation calculator standardized prices to 1/2025. Results 811 carotid endarterectomies (31 with jaw subluxation) and 159 TCAR were performed on 931 unique patients at our institution. Hospital reimbursements favored TCAR (TCAR 66, 113. 57 > endarterectomy 38, 323) and professional reimbursements favored endarterectomy (endarterectomy 1, 707 > TCAR 1, 397). Higher TCAR operating room charges are driven by the higher cost of the TCAR system. The average TCAR system charge was 13, 319 with an additional 9, 147 charge per stent (22, 466 total). The TCAR system outweighs the cost savings from shorter TCAR OR cases (TCAR 164. 60 vs endarterectomy 221. 79 minutes), with cost savings of 10, 809 at an average TCAR OR time of 189 per minute after the first 60 minutes. In comparison, adjuncts for complex endarterectomies such as jaw subluxation, are a fraction of the cost of a TCAR system. Different practice patterns can also affect billing and reimbursements, where neurosurgery endarterectomy charges and reimbursements were significantly different from those of vascular surgery. Conclusion The choice of intervention option (TCAR or endarterectomy) and local practice patterns are the major drivers of charges and reimbursements for carotid interventions. Our institution is incentivized to perform TCARs due to reimbursements greatly outstripping endarterectomy. However, device costs greatly outweigh OR time savings. Carotid endarterectomy remains a significantly cheaper means of managing carotid stenosis compared to TCAR, even with adjuncts such as jaw subluxation or neuromonitoring. Notably charges differed dramatically from reimbursements, underscoring the divergence of charges from true payments.
Huang et al. (Fri,) studied this question.