Surgonomics: the costs of ruptured abdominal aortic aneurysm

Surgical care costs continue to rise at a rate greater than overall U.S. economic growth. Government and industry have vowed to slow the growth of health care spending. Prospective payment systems using the Diagnostic Related Group (DRG) mechanism are being phased in for payment of in-patient hospital care. One expected effect of the DRG payment scheme is a more careful financial analysis of the components of surgical care. The purposes of this study were to examine a vascular procedure, ruptured abdominal aortic aneurysm (RAAA), performed at a large teaching hospital during a ten-year period; to characterize patients by cost (hospital charges exclusive of physician fees) and outcome; and to test the hypothesis that an IDENTIFIER, here the presence or absence and duration of hypotension (less than 90 mm Hg systolic), could predict differences in cost and outcome. The results, in conjunction with historic data, were used to quantify aggregate hospital expenditures for this condition by survivor and the identifier. The results indicate: (1) mortality is higher for the hypotensive patient than for the normotensive patient (p less than 0.05) and is related to the duration of hypotension; (2) lowest mean charges per patient were in the hypotensive more than thirty minutes group ($5,587) followed by normotensive ($28,298), then hypotensive less than thirty minutes ($43,876); and (3) the mean charges for each survivor were $42,447 for normotensive patients versus $107,572 for hypotensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)