Title: Economic Impact of TAVI under monitored local anesthesia in Japan. Single center study.

Backgrounds: As TAVI gets widespread even in Japan, the anesthesia method begins to be found in facilities to transition from general anesthesia (GA) to local anesthesia (LA). In Japanese health insurance system, there is a very large cost coverage difference when TAVI is performed by GA or LA. Therefore, in Japan TAVI is prefer to performed under GA because of the economic aspect of the facilities. Despite of various advantages of LA for TAVI procedure in patients, the economic barrier is still strong to LA. Therefore, this retrospective single center study was conducted to examine how anesthetic method affects the hospital economic managements and also the operation managements. 

Material & Method: We examined TAVI cases (GA: 57 cases LA: 15 cases) in our hospital during the period from September 2015 to December 2016 retrospectively. Cases that changed to surgical AVR due to the occurrence of adverse events, or that data were insufficient were excluded. Main subjects were the staying time in the OR, secondary subjects were the operation time, GA time. Main subjects were analyzed in independent t-test between the GA group and the LA group. 

Result: According to the provisions of Japan, the cost coverage by the insurance system is below: GA: ¥91,800- ≈ €740, LA: ¥1,500- ≈ €12. The staying time in the OR were 113.8 ± 32.7 min in the GA group, 103.1 ± 35.7 min in the LA group (p = 0.27). The operation time were 57.4 ± 22.3 min in the GA group and 59.2 ± 29.9 min in the LA group (p = 0.80). The GA time was 87.6 ± 30.6 min.

Assessment & Discussion: In our hospial, we changed the TAVI operation under GA to under LA from September 2016 because of the Cardiologist's will. The fact that there was no difference in the OR staying time and operating time between the GA group and the LA group, Our procedures and anesthesia in TAVI surgery were sufficiently rationalized. If there is no difference in the OR staying time and operating time due to the anesthesia method, GA is superior in terms of management as the cost coverage by the insurance system.

Conclusion: TAVI under GA in our hospital does not differ from that under LA in the operating room staying time. GA is superior in terms of the cost coverage.

Economic Impact of TAVI under monitored local anesthesia in Japan: single center study