The economic implications of high-risk abdominal aortic aneurysms

Financial data of 102 patients undergoing elective and emergent abdominal aortic aneurysm repair over a 3-year period were evaluated in terms of postoperative length of stay, net revenue, total standard cost, and net margin. Cost reimbursement was based on diagnosis related group payments. Aneurysm repairs were classified as emergent, high-risk elective, or low-risk elective. A net loss of $409,459 was noted for the entire series. Emergent repairs, although only 12% of the population, accounted for 73% of total losses, with a mean loss of $24,655/patient. The mean net loss in the high-risk elective group was $3590/patient, and a net gain of $1132/patient was noted in the low-risk elective group. Length of stay outliers, defined as length of stay greater than 28 days, contributed to the bulk of the losses in the elective series and were predominant in the high-risk group. No preoperative comorbidity, other than high-risk classification, predicted outlier status. Length of stay correlated with total standard costs in all categories of aneurysm repair. Third party payment for length of stay outliers was inadequate; the diagnosis related group system warrants revision so that outlier reimbursement will be based on a tiered system derived from length of stay.