Centers For Medicare Services Research Articles

Factors Contributing to Patient Satisfaction Among VA Medical Center and Non-VA Medical Center Hospitals

IntroductionVeteran satisfaction of care within the Veterans Affairs is typically very high. Yet recommendation ratings of VA medical center (VA) hospitals as measured by Hospital Consumer Assessment of Healthcare Providers and Systems are generally lower than non-VA hospitals.Therefore, it was our objective to assess Veteran satisfaction and recommendation scores and then examine whether satisfaction correlates to recommendation. MethodsWe identified all acute care VAs as our primary analytic cohort. As a comparator group, we also included all acute care academic hospitals (non-VAs), as designated by the Centers for Medicare Services. Using data from Hospital Consumer Assessment of Healthcare Providers and Systems and Strategic Analytics for Improvement and Learning (SAIL) Value Model, we collated patient satisfaction scores, as well as markers of surgical safety from Hospital Compare. We then analyzed the correlation within VAs and non-VAs, primarily focusing the relationship between the “would you recommend Hospital Rating” and subdomains of the “Overall Hospital Rating,” as well as a composite score of patient safety. ResultsA total of 133 VAs and 1116 non-VAs were identified. Among VAs, the “Would you Recommend” hospital rating was significantly and positively correlated with markers of patient satisfaction including care transitions (Pearson's r = 0.59, P = 0.03), Nursing communication (Pearson's R 0.79, P = 0.001), and percent of primary care provider wait times less than 30 min (Pearson's r = 0.25, P = 0.01). VA-recommended scores were negatively correlated with factors such as time to emergency department discharge, and the “leaving the emergency department before being evaluated.” When looking at non-VAs, correlation directions were similar, albeit with stronger associations at almost every metric. While recommended scores correlated strongly to overall hospital ratings for both groups, VAs had no significant correlation between “would you recommend” and patient safety. However, there was a slight negative correlation between patient safety and “recommend” among non-VAs. ConclusionsAlthough satisfiers and dissatisfiers of care appear similar between VAs and non-VAs, “would you recommend” is a far weaker marker of patient perceptions of safety and quality. These seemingly empathetic markers such as “would you recommend” should be used with caution as they may not address the fundamental question being asked.

330 Accuracy and Clinical Significance of Neurosurgical Patient Safety Indicator Events Reported by Centers for Medicare Services

INTRODUCTION: Data on patient safety indicator (PSI) events are used by Center for Medicare Services (CMS) for determining reimbursement to hospitals, and public quality reporting. It is unclear whether the process used by CMS to detect PSI events is accurate, and whether PSI events affect clinical outcomes in neurosurgical patients. METHODS: We reviewed CMS reported PSI events in neurosurgical patients at our hospital from July 1, 2018, through December 31, 2019. Discharge billing codes were reviewed in order to assess whether CMS criteria for PSI were met. Charts were reviewed by experienced clinicians in order to assess the accuracy and clinical significance of CMS reported PSI events. For deep venous thrombosis/pulmonary embolism (DVT/PE) PSI events, chart reviews were performed in order to assess whether standard of care prophylaxis was administered. RESULTS: 14 PSI events were reported in 11 patients, representing 1.3% of neurosurgical procedures in fee for service medicare patients. 7 patients underwent spinal surgery and 4 underwent cranial surgery. PSI events included DVT/PE (n = 6), postoperative hematoma (n = 2), postoperative respiratory failure (n = 5), and iatrogenic pneumothorax (n = 1). Only 10/14 PSI events (71%) met CMS criteria based on discharge billing codes, and only 8/14 PSI events (57%) met CMS criteria based on chart review. All PSI events that were confirmed based on chart review required specific medical or surgical treatment, but only 5 (63%) led to increased length of stay, and no patients had residual adverse effects at hospital discharge. 5/6 patients with chart confirmed DVT/PE (83%) received standard of care DVT prophylaxis. CONCLUSIONS: CMS-reported PSI events have significant rates of inaccuracy. PSI events may not correlate with meaningful adverse clinical outcomes. DVT/PE PSI events were not associated with breaches in standard of care.

Estimated costs of preoperative evaluation of postmenopausal hysterectomy for prolapse at a safety-net hospital: an observational descriptive study

BACKGROUNDIn practice, preoperative evaluation prior to hysterectomy varies. Unnecessary preoperative evaluation may add cost and risk with little benefit to the patient.OBJECTIVEThis study aimed to describe practice patterns and the associated costs related to preoperative evaluations before hysterectomy for prolapse at a safety-net hospital.STUDY DESIGNThis was a retrospective cohort study of postmenopausal women who underwent a hysterectomy for prolapse. Nonfacility-associated cost data were obtained from the Centers for Medicare Services. The biopsy cost was estimated to be $172.55 and $125.23 for ultrasounds.RESULTSA total of 505 postmenopausal cases were identified. Of those, 155 (31%) underwent a preoperative biopsy, 305 (60%) had an ultrasound, and 124 (25%) had both. Of those, 72.9% had an indication for a biopsy. A total of 64 biopsies and 216 ultrasounds lacked clear indication. Of those, 56 biopsies were performed for bleeding in cases with an endometrial thickness of <4 mm. The total cost of nonvalue-added testing was $42,576.CONCLUSIONAdherence to a strict preoperative algorithm would have saved $38,092 over the study period, although 0.50% of these biopsies would potentially have detected endometrial cancer preoperatively. These results underscore the value of clinical algorithms at teaching institutions.

The Dark Side of Chasing the Perfect Donor. Is it Time for Us to Change Cardiac Transplant Program Performance Metrics?

The Dark Side of Chasing the Perfect Donor. Is it Time for Us to Change Cardiac Transplant Program Performance Metrics?

Incorporating Point-of-Care Bacterial Fluorescence into a Wound Clinic Antimicrobial Stewardship Program.

Background: In 2014 the World Health Organization (WHO) warned of an emerging world-wide crisis of antibiotic-resistant microorganisms. In response, government and professional organizations recommended that health care systems adopt antimicrobial stewardship programs (ASPs). In the United States, the Centers for Medicare Services (CMS) mandated antimicrobial stewardship in the hospital inpatient setting. Effective 1 January 2020, the Joint Commission required ambulatory centers that prescribe antibiotics, such as wound centers, to institute an ASP. Chronic wounds often remain open for months, during which time patients may receive multiple courses of antibiotics and numerous antimicrobial topical treatments. The wound clinician plays an integral role in reducing antimicrobial resistance in the outpatient setting: antibiotics prescribed for skin and soft tissue infections are among the most common in an outpatient setting. One of the most challenging aspects of antimicrobial stewardship in treating chronic wounds is the inaccuracy of bacterial and infection diagnosis. Methods: Joint Commission lists five elements of performance (EP): (1) identifying an antimicrobial stewardship leader; (2) establishing an annual antimicrobial stewardship goal; (3) implementing evidence-based practice guidelines related to the antimicrobial stewardship goal; (4) providing clinical staff with educational resources related to the antimicrobial stewardship goal; and (5) collecting, analyzing, and reporting data related to the antimicrobial stewardship goal. This article focuses on choosing and implementing an evidence-based ASP goal for 2020. Discussion: Clinical trials have demonstrated the ability of fluorescence imaging (MLiX) to detect clinically significant levels of bacteria in chronic wounds. Combined with clinical examination of signs and symptoms of infection, the MLiX procedure improves the clinician’s ability to diagnose infection and can guide antimicrobial use. In order to satisfy the elements of performance, the MLiX procedure was incorporated into the annual ASP goal for several wound care centers. Clinicians were educated on the fluorescence imaging device and guidelines were instituted. Collection of antimicrobial utilization data is underway.

Readmissions after endoscopic skull base surgery: associated risk factors and prevention.

Unplanned readmissions within 30 days of discharge is a quality measure introduced by the Centers for Medicare Services. This measure has been used to rate hospital quality and also to penalize hospitals for excess readmissions. It has been hypothesized that shorter hospital stays and fewer readmissions are associated with endoscopic skull base procedures. In this study we analyze endoscopic skull base procedures performed at our institution over a 10-year period to identify rates and factors associated with readmissions after endoscopic skull base surgery. A retrospective chart review was performed at a tertiary care academic medical center identifying patients who underwent endoscopic skull base surgery over the past 10 years. Data on patient demographics and tumor variables, as well as patient variables such as body mass index (BMI), revision surgery, history of skull base radiation, medical comorbidities, intraoperative cerebrospinal fluid (CSF) leaks, and postoperative CSF leaks, were recorded. Eight hundred thirty-three patients were included in our study. Sixty-one patients (7.3%) were readmitted a total of 66 times within 30 days. The most common reasons were as follows: hyponatremia (n = 18); CSF leak (n = 17); epistaxis (n = 3); diabetes insipidus (n = 3); rhinorrhea (n = 3); as well as other reasons. Statistical analysis revealed that the presence of intraoperative CSF leak was the only statistically significant variable associated with increased rate of readmissions within 30 days of discharge (p < 0.001). Presence of intraoperative CSF leak was the only statistically significant variable associated with an increased risk for readmission after surgery. Other tumor and patient variables were not associated with an increased risk of readmission within 30 days.

Risk assessment of post-discharge mortality among recently hospitalized Medicare heart failure patients with reduced or preserved ejection fraction

Objective: Targeted care management for hospitalized patients with acute decompensated heart failure (ADHF) with reduced or preserved ejection fraction (HFrEF/HFpEF) who are at higher risk for post-discharge mortality may mitigate this outcome. However, identification of the most appropriate population for intervention has been challenging. This study developed predictive models to assess risk of 30 day and 1 year post-discharge all-cause mortality among Medicare patients with HFrEF or HFpEF recently hospitalized with ADHF.Methods: A retrospective study was conducted using the 100% Centers for Medicare Services fee-for-service sample with complementary Part D files. Eligible patients had an ADHF-related hospitalization and ICD-9-CM diagnosis code for systolic or diastolic heart failure between 1 January 2010 and 31 December 2014. Data partitioned into training (60%), validation (20%) and test sets (20%) were used to evaluate the three model approaches: classification and regression tree, full logistic regression, and stepwise logistic regression. Performance across models was assessed by comparing the receiver operating characteristic (ROC), cumulative lift, misclassification rate, the number of input variables and the order of selection/variable importance.Results: In the HFrEF (N = 83,000) and HFpEF (N = 123,644) cohorts, 30 day all-cause mortality rates were 6.6% and 5.5%, respectively, and 1 year all-cause mortality rates were 33.6% and 29.5%. The stepwise logistic regression models performed best across both cohorts, having good discrimination (test set ROC of 0.75 for both 30 day mortality models and 0.74 for both 1 year mortality models) and the lowest number of input variables (18–34 variables).Conclusions: Post-discharge mortality risk models for recently hospitalized Medicare patients with HFrEF or HFpEF were developed and found to have good predictive ability with ROCs of greater than or equal to 0.74 and a reasonable number of input variables. Applying this risk model may help providers and health systems identify hospitalized Medicare patients with HFrEF or HFpEF who may benefit from more targeted care management.

IMPLEMENTING A NURSE RUN ANNUAL WELLNESS VISIT

The Medicare Annual Wellness Visit (AWV) is a free service offered to Medicare Part B beneficiaries annually to promote preventive care and reduce unnecessary utilization of health care services. The Centers for Medicare Services allows registered nurses to conduct the AWV and generate similar revenue to when a physician conducts the visit. Through the Northern New England Geriatric Workforce Enhancement Program (GWEP), we engaged twelve practices to implement the AWV as a nurse run visit. By implementing the nurse run AWV, a practice could increase utilization of AWV, increase employee and patient satisfaction, and increase revenue. One site was able to increase billing (non-facility price) by 212% and Relative Value Units (RVU) by 190% by implementing the Nurse Run AWV.

A Prospective, Interventional Study Evaluating the Use of a Prompt to Improve Compliance with Documentation of a Plan of Care for Pain in Patients with Bone Metastases Seen for Palliative Radiation Therapy

Management of cancer-related pain is an essential component of comprehensive oncologic care. Undertreated pain results in adverse clinical outcomes, undue suffering, and decreased quality of life. Furthermore, there are significant disparities in pain management, with racial/ethnic minorities and underserved populations at higher risk for undertreated cancer related pain. We studied whether the use of a simple electronic medical record (EMR) prompt could increase compliance with documentation of pain interventions in patients seen for palliative radiotherapy for bone metastases. A prospective, interventional study was approved by the Resident and Fellow Quality Improvement Incentive Program at our institution. Evaluable patients were seen in consultation for palliative radiation therapy for bone metastases. Resident physicians were asked to imbed a prompt in their consultation note, including pain scale (0/10) and plan of care for pain management. The primary endpoint was compliance rate of documenting a plan of care for >50% of audited patient encounters. The protocol aligned with Merit-based Incentive Payment System (MIPS) quality measures as defined by the Centers for Medicare Services. Quarterly EMR review was performed, with charts selected at random for auditing. Prior to initiation of the QI protocol, a pain intervention was documented in just 17.2% of patients. In the first 6 months following institution of the QI protocol, a plan of care for pain was documented in 65.5% of patients. The analgesic regimen was assessed or modified in 35% of consultations, urgent radiation therapy undertaken in 26%, communication with primary provider or oncologist in 10%, and referral to the Palliative Care service in just 4%. After institution of this protocol for patients being evaluated for palliative radiotherapy for bone metastases, substantially more patients had documentation of a plan of care for pain in accordance with MIPS quality guidelines. In addition to offering palliative radiation therapy, analgesics regimens were adjusted, referrals to palliative care were offered, and pain control was discussed with the referring provider. Ongoing efforts in our department are aimed at improving pain management and integrating radiation therapy with specialized palliative care providers.

TCT-670 Difference in Post-SAVR Inpatient Outcomes between TAVR and non-TAVR Performing Hospitals

The Centers for Medicare Services (CMS) has imposed restrictions on which cardiac surgery programs can offer TAVR. This is now likely impacting patient selection for SAVR based on whether a program can offer TAVR. Therefore, it is paramount to investigate if outcomes for SAVR differ at TAVR

Potential Impact of the DRIP Score on Antibiotic Use: a Retrospective Single-Center Study

BackgroundThe Drug Resistance in Pneumonia score (DRIP) is a recently developed prediction tool to identify patients with community-acquired pneumonia (CAP) at increased risk for drug resistant pathogens (DRP). The DRIP score has better performance characteristics than other available prediction tools which have been associated with increased broad-spectrum antibiotic use. We evaluated the potential impact of the DRIP score on CAP management at the Salt Lake City VA, a 106 bed facility with a Hospitalist service staffed by Internal Medicine residents and Department of Medicine faculty and an antibiotic stewardship program (ASP).MethodsWe performed a retrospective chart review of adult inpatients with pneumonia present on admission based on ICD9/10 coding between February 2016 and April 2017. Both DRIP and HCAP scores were calculated for each patient and antibiotic selection was collected by manual chart review. We compared actual antibiotic selection with potential changes in broad-spectrum antibiotic use in all patients and patients with a DRIP score ≥4, the cutoff where broad-spectrum antibiotic use is suggested. Microbiology results, mortality, and 30-day readmission were also collected.ResultsWe identified 184 patients during the study period. Respiratory cultures were obtained in 27% (50/184) of participants with 2% (3/184) positive for a CAP-DRp. 7% (12/169) were positive for MRSA colonization upon admission. 24% (45/184) had DRIP ≥4 as compared with 47% (87/184) meeting HCAP criteria. 158 were treated for bacterial pneumonia of which 85% (134/158) received CAP antibiotics. Strict DRIP adherence upon admission would have led to 13% (21/158) more patients on broad-spectrum antibiotics. In the subset of patients with a DRIP score ≥4, DRIP adherence would have led to 65% (26/40) more patients on broad-spectrum antibiotics. 30-day mortality (9%) and readmission (15%) rates were comparable with Centers for Medicare Services (CMS) statistics.ConclusionIn the setting of robust ASP efforts and low rates of DRPs, the DRIP score may lead to increased use of broad-spectrum antibiotics. The impact of the DRIP score on antibiotic use and clinical outcomes warrants further large-scale evaluation in a variety of settings.Disclosures All authors: No reported disclosures.

How Does State Income and the Number of Uninsured Patients Relate to Hospital Charges for Spine Care?

Patients and policy makers are increasingly scrutinizing health care costs. Using data from the Centers for Medicare Services, our group has demonstrated that hospital charge and reimbursement rates for spine care have significant regional variation across the country.

Drug-Related Problems and Hospital Admissions in Cardiac Transplant Recipients

Drug-related problems (DRPs) in the general population account for 15% of all hospital admissions, of which approximately 30% are preventable. Cardiac transplant patients may be at increased risk for DRPs because of their complicated medication regimens that include drugs with a narrow therapeutic index. To determine the incidence and preventability of DRPs causing hospital admission in cardiac transplant patients at a single institution. Between November 2009 and January 2010, a prospective longitudinal study investigated the incidence and preventability of DRPs in a single cardiac transplant center. Three independent reviewers used validated scoring systems to determine the incidence and preventability of drug-related hospital admissions. DRPs were classified by type, pharmacologic class, and impact on length of stay. During the 3-month study period, 48 cardiac transplant patients were hospitalized. DRPs accounted for 40% (19/48) of these admissions and 58% (11/19) were adjudicated to be preventable. Common DRPs included supratherapeutic (32%) and subtherapeutic (16%) dosage, adverse drug reaction (32%), drug interaction (5%), and nonadherence (5%). Pharmacologic classes implicated included immunosuppressant (63%), antimicrobial (11%), electrolyte/fluid (11%), and anticoagulant (5%). Average length of stay in drug-related compared to non-drug-related admissions was 11.4 versus 8.5 days (p = 0.458). When annualized, 44 hospitalizations or 500 hospital days may have been prevented. Hospital admissions following cardiac transplantation are often drug related (40%) and preventable (58%). Incorporating this insight into the multidisciplinary transplant team may improve outcomes, assist in meeting national quality mandates by the United Network for Organ Sharing and Centers for Medicare Services, and lead to new benchmarks for transplant centers.

The D&amp;T Report

The D&amp;T Report

Surgical Antibiotic Prophylaxis—Focus on Dosing

THE CENTERS FOR Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) implemented the Surgical Infection Prevention (SIP) project in August 2002. A panel of experts developed three measures for national surveillance and quality improvement: (1) prophylactic antibiotic received within one hour before surgical incision, (2) prophylactic antibiotic is consistent with currently published guidelines, and (3) prophylactic antibiotic is discontinued within 24 hours after the end of surgery. The goal of the SIP project was to reduce morbidity and mortality from postoperative surgical site infections (SSIs), which account for 14 to 16% of all hospital-acquired infections.

Disparities in the treatment of patients with IL-2 for metastatic renal cell carcinoma

Objectives The incidence of metastatic renal cell cancer (mRCC) is rising. To date, interleukin-2 (IL-2) is the only treatment offering a complete response rate for mRCC. We wish to test the hypothesis that the combination of restricted availability and expense associated with IL-2 administration results in differential access to the medication based on race and sex, despite similar clinical indications for its use. Methods We used data from the Surveillance, Epidemiology, and End Results program and the Centers for Medicare Services (CMS) to clinically characterize subjects with mRCC diagnosed from 1992 through 2002. We linked these subjects to claims identified in the CMS databases. We then assigned subjects to cohorts receiving radical nephrectomy, IL-2, both, or neither. A logistic model was created to identify factors that had significant independent effects on the receipt of IL-2. Results Three thousand seven hundred thirty individuals were identified with mRCC. After controlling for other variables, female subjects were less likely to receive IL-2 (O.R. 0.80). African American subjects were also less likely to receive IL-2 (O.R 0.55). Married individuals were much more likely to receive IL-2 (O.R 1.9). Conclusions African Americans and women were much less likely to be treated with IL-2 after controlling for relevant clinical variables. These data document that the only therapy offering a complete response to patients with mRCC is less frequently given to those who are African American or female. It is possible that the racial and gender-based disparities in treatment with IL-2 will be replicated with newer, expensive treatment options for mRCC. Further prospective investigation into mitigating barriers to receipt of effective care for mRCC is urgently needed.

Laboratory reimbursement--competitive bidding and after.

1. Judy Davis Will 2008 be considered a watershed year for clinical laboratory Medicare reimbursement? Early in the year laboratories faced a dismal reimbursement future with a competitive bidding demonstration project scheduled to begin in San Diego in July, along with a soon-to-be announced second site. Fast forward to August and Congress has repealed CMS's authority to implement the demonstration, legislation has been introduced to re-engineer the laboratory fee schedule, and laboratories are poised to receive a 4.5% update beginning January 1, 2009. Let's look at how these paradigm changes occurred and the potential impact in the future. The 2003 Medicare Modernization Act, best known for implementing a prescription drug benefit for seniors, also included a provision for a competitive bidding demonstration project for Medicare Part B clinical laboratory services to occur in two areas. Despite ongoing opposition from the entire clinical laboratory industry, the Centers for Medicare Services (CMS) has proposed competitive bidding for laboratory services multiple times in the past. The industry remains concerned that when a limited number of laboratories are selected to provide all testing in an area, primarily based on cost, significant incentives exist to bid below cost such that quality of testing may be compromised and beneficiary access is reduced. Competitive bidding came closer to fruition this time than previously—San Diego was named the first site and bids were submitted. The process was delayed shortly before winners were to be announced in April when a preliminary injunction was granted in response to a lawsuit against CMS, filed…

Poster 264: Early Effects of the Centers for Medicare Services Criteria on Patient Care Following Total Joint Arthroplasty

Objective: To examine the early effects of the Centers for Medicare Services (CMS) criteria for eligibility for rehabilitation following total knee (TKA) and hip (THA) arthroplasty on patient discharge dispositions and acute care length of stay (LOS) and hospital charges. Design: Retrospective, exploratory study. Setting: A tertiary care hospital and affiliated inpatient rehabilitation hospital. Participants: Patients with TKA and THA; clinical data repository information and medical records of patients from 2000 and 2006.

Preventing tomorrow's sudden cardiac death today: Part I: Current data on risk stratification for sudden cardiac death

Accurate and timely prediction of sudden cardiac death (SCD) is a necessary prerequisite for effective prevention and therapy. Although the largest number of SCD events occurs in patients without overt heart disease, there are currently no tests that are of proven predictive value in this population. Efforts in risk stratification for SCD have focused primarily on predicting SCD in patients with known structural heart disease. Despite the ubiquity of tests that have been purported to predict SCD vulnerability in such patients, there is little consensus on which test, in addition to the left ventricular ejection fraction, should be used to determine which patients will benefit from an implantable cardioverter defibrillator. On July 20 and 21, 2006, a group of experts representing clinical cardiology, cardiac electrophysiology, biostatistics, economics, and health policy were joined by representatives of the US Food and Drug administration, Centers for Medicare Services, Agency for Health Research and Quality, the Heart Rhythm Society, and the device and pharmaceutical industry for a round table meeting to review current data on strategies of risk stratification for SCD, to explore methods to translate these strategies into practice and policy, and to identify areas that need to be addressed by future research studies. The meeting was organized by the Duke Center for the Prevention of SCD at the Duke Clinical Research Institute and was funded by industry participants. This article summarizes the presentations and discussions that occurred at that meeting.

A decade of change in abdominal aortic aneurysm repair in the United States: Have we improved outcomes equally between men and women?

Abdominal aortic aneurysm (AAA) repair has undergone vast changes in the last decade. We reviewed a national database to evaluate the effect on utilization of services and rupture rates. From the Centers for Medicare Services (CMS), a 5% inpatient sample was obtained for 1994 to 2003 as beneficiary encrypted files (5% BEF) and as a limited data set file after 2001. Files were translated into Microsoft Access by using a custom program. Queries were performed using International Classification of Diseases (9th Revision) (ICD-9) diagnosis codes 441.3 (ruptured AAA) or 441.4 (non-ruptured AAA) and ICD-9 procedure codes 38.34, 38.36, 38.44, 38.64, 39.25, 39.52 for open, and 39.71 (available after October 2000) for endovascular repair. The 5% BEF totals were multiplied by 20 to calculate yearly volumes. Total cases were divided into the yearly CMS population of elderly Medicare recipients for repair rates per capita and are reported as cases per 100,000 elderly Medicare recipients. Statistics were performed using chi2, Student's t test, nonparametric tests, and multiple regression analysis; P < or = .05 was considered significant. Elective AAA repairs declined from 94.4/100,000 in 1994 to 87.7/100,000 in 2003. AAA rupture surgery declined from 18.7/100,000 (1994) to 13.6/100,000 (2003). Rupture repairs from 1994 to 2003 decreased by 29% for men and by 12% for women (P < .001). Rupture mortality has not changed, but the average is significantly higher for women at 52.8%, with men averaging 44.2% (P < .001). Mortality for elective AAA repair has decreased from 5.57% (1994) to 3.20% (2003) in men (P < .001) and from 7.48% (1994) to 5.45% (2003) in women (P < .001). Multivariate analysis demonstrated increasing age, female sex, and open surgery (vs endovascular) were significant predictors of elective and ruptured AAA repair mortality. For 2003 elective AAA repairs, the average length of stay was 6.9 days in men and 8.9 days in women (P < .01) For 2003, men were more likely to be discharged to home after rupture (32.9% of men vs 23.3% of women; P < .001) and elective repair (84.5% of men vs 70.1% of women; P < .001). Improvements in AAA management in the last decade have decreased aneurysm-related deaths and reduced the incidence of aneurysm ruptures, with a lower utilization of services. Women, however, continue to have a consistently higher mortality for open and ruptured AAA repair and are less likely to return to home after either.