Hospital-level variation in costs of elective nonruptured abdominal aortic aneurysm repair

Abstract

BackgroundWith the aging population in the United States, the incidence of abdominal aortic aneurysms is shifting to older ages. Given changing demographic characteristics and increasing health care expenditures, the present study evaluated the degree of center-level variation in the cost of elective abdominal aortic aneurysm repair. MethodsWe identified all adult (≥18 years) hospitalizations for elective repair of nonruptured abdominal aortic aneurysms in the 2017 to 2020 Nationwide Readmissions Database. Hierarchical mixed-effects models were used to rank hospitals based on risk-adjusted costs. The interclass coefficient was used to calculate the amount of variation attributable to hospital-level characteristics. High-cost hospitals were classified as centers in the top decile of costs. The association of high-cost hospitals status with outcomes of interest was examined. ResultsAn estimated 62,626 patients underwent abdominal aortic aneurysm repair, and 5,011 (8.0%) were managed at high-cost hospitals. Compared with non–high-cost hospitals, high-cost hospitals were more commonly large (52.6% vs 48.3%) metropolitan (78.3% vs 66.9%) teaching centers (all P < .001). The interclass coefficient found that 28% of the observed variation in cost is attributable to hospital factors. After adjustment, high-cost hospitals were associated with increased odds of gastrointestinal (adjusted odds ratio = 1.42; 95% CI, 1.05–1.90) and infectious (adjusted odds ratio = 1.35; 95% CI, 1.14–1.59) complications. Finally, the Elixhauser index (β = +$2,700/unit; 95% CI, $2,500–$3,000) and open repair (β = +$4,100; 95% CI, $3,100–$5,200) were associated with increased costs. ConclusionWe observed significant variation in cost attributable to center-level differences. Our findings have implications for reimbursement paradigms and the establishment of quality and cost benchmarks in the elective repair of abdominal aortic aneurysm.