PC132 The Institutional Cost of Ruptured Aneurysms: Implications for Tertiary Care Medical Centers

Abstract

As care of vascular emergencies becomes more regionalized, the cost of providing emergency care to patients with ruptured aneurysms rests largely on tertiary medical centers. These lifesaving procedures may place excessive fiscal strain on an already overtaxed system. The objective of this study was to define and quantify the cost of repairing ruptured aneurysms and compare treatment modalities. From 2013 to 2015, 82 ruptured abdominal and thoracic aortic aneurysms were treated operatively at our 734-bed tertiary referral center. For each case, total hospital payments, overall cost, and hospital margin were calculated. Direct variable costs were itemized and included operating room costs, anesthesia, operating room supplies/implants, imaging, medications, emergency department costs, and room and board. Case-mix index and length of stay were recorded and benchmarked against other large (≥500 bed) academic medical centers using risk-adjusted University Health System Consortium data. The 82 ruptured aortic aneurysms treated over the 2-year period included 55 abdominal aneurysms (rAAA) and 27 thoracic aneurysms (rTAA). Of the rAAA patients, 41 were treated with endovascular repair (EVAR) and 12 underwent open repair. The mean overall cost of EVAR was $39,341, with a hospital margin of $1462 for the admission. The mean overall cost of open repair was $49,280, with a hospital margin of $5465 for the admission. The highest direct variable costs for EVAR were implants (48%) and room/board (32%); the highest for open was room/board including intensive care unit (45%). Case-mix indices were comparable (4.1 for EVAR vs 4.5 for open repair). Mean length of stay was 9.2 days in the EVAR group and 16.7 days in the open repair group. There overall length of stay for rAAA was similar between our institution and other large academic medical centers (10.9 vs 10.6 days). Emergency ruptured aneurysm repair at a tertiary care center is an expensive endeavor with a narrow margin. Despite increased length of stay and higher overall costs, hospital reimbursement was substantially better for open rAAA repair (profit margin 11.1% vs 3.6% for EVAR). Without reform of reimbursement for emergent procedures, repair of ruptured aneurysms may be difficult to sustain in the era of cost containment.