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Institutional Cost of Unplanned 30-Day Readmission Following Open and Endovascular Surgery
Adam S A Gracon1, Tiffany W Liang1, Thomas S Easterday2
1Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, IN, USA.
Insights
The cost of open and endovascular vascular procedures, including 30-day readmissions, is similar. However, patients readmitted after vascular surgery incurred higher index hospitalization costs regardless of procedure type.
Area of Science:
- Vascular Surgery
- Health Economics
- Healthcare Management
Background:
- Vascular surgical patients face high readmission rates.
- The economic impact of these readmissions remains understudied.
- Characterizing costs associated with index hospitalizations and readmissions is crucial for resource allocation.
Purpose of the Study:
- To compare the costs of index hospitalization and 30-day readmissions for open versus endovascular vascular procedures.
- To analyze the financial implications of readmissions in vascular surgery patients.
- To identify cost drivers related to readmission in vascular surgery.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program database (2011-2012).
- Obtained variable and fixed costs for index hospitalizations and readmissions using SAP BusinessObjects.
- Analyzed patient characteristics and outcomes using appropriate statistical tests (t-tests, Wilcoxon rank-sum, Fisher exact).
Main Results:
- Analysis included 1026 inpatient procedures (59% open, 41% endovascular).
- 30-day unplanned readmission rates were comparable: 16.9% for open and 17.8% for endovascular (P = .679).
- Mean index hospitalization costs (open: $27,653; endovascular: $23,999) and 30-day readmission costs (open: $19,117; endovascular: $17,887) were similar between groups.
- Readmitted patients incurred higher mean index hospitalization costs ($31,115 vs $28,321 for open; $32,262 vs $26,908 for endovascular).
Conclusions:
- Index hospitalization and 30-day readmission costs do not significantly differ between open and endovascular vascular procedures.
- Readmission is associated with increased overall index hospitalization costs, irrespective of the surgical approach.
- These findings highlight the financial burden of readmissions in vascular surgery.
Background:
Vascular surgical patients have a high rate of readmission, and the cost of readmission for these patients has not been described. Herein, we characterize and compare institutional index hospitalization and 30-day readmission cost following open and endovascular vascular procedures.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program database was used to identify inpatient open and endovascular procedures at a single institution, from January 2011 through June 2012. Variable and fixed costs for index hospitalization and unplanned 30-day readmissions were obtained using SAP BusinessObjects. Patient characteristics and outcome variables were analyzed using Student t tests or Wilcoxon rank-sum nonparametric tests for continuous variables and Fisher exact tests for categorical variables.
Results:
One thousand twenty-six inpatient procedures were included in the analysis. There were 605 (59%) open and 421 (41%) endovascular procedures with a 30-day unplanned readmission rate of 16.9% and 17.8%, respectively (P = .679). The mean index hospitalization costs for open and endovascular procedures were US$27 653 and US$23 999, respectively (P = .146). The mean costs for 30-day unplanned readmission for open and endovascular procedures were US$19 117 and US$17 887, respectively (P = .635). Among open procedures, the mean cost for patients not readmitted was US$28 321 compared to US$31 115 for those readmitted (P = .003). Among endovascular procedures, the mean cost for patients not readmitted was US$26 908 compared to US$32 262 for those readmitted (P = .028).
Conclusion:
The cost of index hospitalization and 30-day unplanned readmission are similar for open and endovascular procedures. Readmitted patients had a higher mean index hospitalization cost irrespective of open or endovascular procedure.
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