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Preventable Complications Driving Rising Costs in Management of Patients with Critical Limb Ischemia. Ann Vasc Surg 2016 May;33:144-8

Date

02/27/2016

Pubmed ID

26916348

DOI

10.1016/j.avsg.2015.11.026

Scopus ID

2-s2.0-84961231179   6 Citations

Abstract

BACKGROUND: This study aimed to identify factors that drive increasing health-care costs associated with the management of critical limb ischemia in elective inpatients.

METHODS: Patients with a primary diagnosis code of critical limb ischemia (CLI) were identified from the 2001-2011 Nationwide Inpatient Sample. Demographics, CLI management, comorbidities, complications (bleeding, surgical site infection [SSI]), length of stay, and median in-hospital costs were reviewed. Statistical analysis was completed using Students' t-test and Mann-Kendall trend analysis. Costs are reported in 2011 US dollars corrected using the consumer price index.

RESULTS: From 2001 to 2011, there were a total of 451,823 patients who underwent open elective revascularization as inpatients for CLI. Costs to treat CLI increased by 63% ($12,560 in 2001 to $20,517 in 2011, P < 0.001 in trend analysis). Endovascular interventions were 20% more expensive compared with open surgery ($19,566 vs. $16,337, P < 0.001). Age, gender, and insurance status did not affect the cost of care. From 2001 to 2011, the number of patient comorbidities (7.56-12.40) and percentage of endovascular cases (13.4% to 27.4%) increased, accounting for a 6% annual increase in total cost despite decreased median length of stay (6 to 5 days). Patients who developed SSI had total costs 83% greater than patients without SSIs ($30,949 vs. $16,939; P < 0.001). Patients who developed bleeding complications had total costs 41% greater than nonbleeding patients ($23,779 vs. $16,821, P < 0.001). Overall, there was a 32% reduction in SSI rates but unchanged rates of bleeding complications during this period.

CONCLUSIONS: The cost of CLI treatment is increasing and driven by rising endovascular use, SSI, and bleeding in the in-patient population. Further efforts to reduce complications in this patient population may contribute to a reduction in health care-associated costs of treating CLI.

Author List

Dua A, Desai SS, Patel B, Seabrook GR, Brown KR, Lewis B, Rossi PJ, Malinowski M, Lee CJ

Authors

Brian D. Lewis MD Professor in the Surgery department at Medical College of Wisconsin
Michael Malinowski MD Associate Professor in the Surgery department at Medical College of Wisconsin
Peter J. Rossi MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Cost Savings
Cost-Benefit Analysis
Critical Illness
Databases, Factual
Elective Surgical Procedures
Endovascular Procedures
Female
Hospital Costs
Humans
Ischemia
Male
Postoperative Hemorrhage
Retrospective Studies
Surgical Wound Infection
Time Factors
Treatment Outcome
United States
Vascular Surgical Procedures
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc