Competing on price for chest-port insertion, IR trounces surgery: study

When it comes to inserting chest ports for venous access needed for repeated blood draws and drug administrations, interventional radiologists working in IR suites can do the job at far lower cost—yet with no greater rates of infection or complications—than surgeons in the OR.

Nor is the difference a token amount. The study reporting the finding, published in the June edition of the Journal of the American College of Radiology, showed the OR costing 193 percent more than the IR suite for chest-port insertion. Room expenses were higher in the OR for every variable, including labor, supply and fixed costs.

Just as impressive, the IR suites were faster, averaging 36.9 minutes versus 69 minutes in the OR.

Led by Jennifer LaRoy, a medical student at the Medical College of Wisconsin in Milwaukee, who was supported by a 2013 RSNA student grant, study authors compared data from 478 charts from two cohorts of patients, 239 in each, who had chest ports placed in the IR and OR. The researchers compiled comparisons of around 50 factors with likely price implications. For example, they found OR patients had more cases of tip malposition and venous thrombosis than IR patients.

While the study suggests that an IR suite is clearly the more cost-effective site for chest-port insertion, a “case could be made for chest-port placement to be done exclusively in a dedicated ambulatory setting by surgeons and/or interventionalists, rather than in academic centers,” the authors concluded. “In this way, both surgeons and interventional radiologists would be able to perform these procedures while minimizing overhead costs, thus decreasing the cost to the patient.”

Commenting on the study for RSNA News this past spring, Parag J. Patel, MD, an assistant professor of radiology and surgery at the Medical College of Wisconsin and a scientific advisor for the study, connected the timing of the study with unsustainable spending levels in U.S. healthcare.

“When we get to a point where we need to make cuts,” he said, “studies like ours will help us make data-driven informed decisions on how to more efficiently practice medicine.”

The study noted that surgeons continue to implant most chest ports, handling 62.4 percent of the procedures in 2011, but radiologists performed 27 percent of placements in 2011, up from 17.4 percent in 2004.