Policies Designed to Reduce Hospital Readmissions May Result in Increased Limb Loss

Abstract

Methods: Vascular Quality Initiative (VQI) data for 465 EVAR and 431 OAAA were linked to cost data at two centers. High-cost cases were defined as those in the upper quartile of cost for each procedure at each center. VQI data elements were then examined for their relative risk of predicting a high-cost outcome. Total cost of hospitalization for AAA repair was the cost measure evaluated. Categoric variables were tested by c and continuous variables by two-sample t-test. Results: The cost of OAAA (mean, $28,183; range, $12,557$266,615) and EVAR (mean, $32,6546; range, $11,926-$60,894) at center A were compared with OAAA (mean, $27,744; range, $7139$583,701) and EVAR (mean, $26,634; range, $5372-$302,111) at center B. Factors linked to high cost are reported in the Table. Conclusions: Markers of adverse intraoperative performance and postoperative complications were better predictors of high-cost hospitalizations than preoperative patient characteristics in both OAAA and EVAR patients. Future efforts to optimize costs in all AAA repairs should focus on improving intraoperative performance. This strategy differs from other quality efforts where risk-adjusted models using preoperative patient characteristics were developed to aid patient selection. The total cost of EVAR (and potential applicability of this technology at a given center) is significantly affected by the structure of local stent graft contracting.