The Institutional Cost of Ruptured Aneurysms: Implications for Tertiary Care Medical Centers
Courtney J. Warner, MD, Kanwaldeep Williams, Mandeep S. Sidhu, Ferdinand J. Venditti, R. Clement Darling, III, MD.
Albany Medical College, Albany, NY, USA.
Objectives: As care of vascular emergencies becomes more regionalized, the cost of providing emergent 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 is to define and quantify the cost of repairing ruptured aneurysms and compare treatment modalities.
Methods: From 2013-2015, 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 OR costs, anesthesia, OR supplies/implants, imaging, medications, ED costs, and room and board. Case mix index and length of stay (LOS) were recorded and benchmarked against other large (500+ bed) academic medical centers using risk-adjusted University Health System Consortium (UHC) data.
The 82 ruptured aortic aneurysms treated over the two year period included 55 abdominal aneurysms (rAAA) and 27 thoracic aneurysms (rTAA). Of the rAAA patients, 41 were treated with EVAR and 12 underwent open repair. The mean overall cost of EVAR was $39,341, with a hospital margin of $1,462 for the admission. The mean overall cost of open repair was $49,280, with a hospital margin of $5,465 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 ICU (45%). Case mix indices were comparable (4.1 for EVAR vs 4.5 for open repair). Mean LOS was 9.2 days in the EVAR group and 16.7 days in the open repair group. There overall LOS for rAAA was similar between our institution and other large academic medical centers (10.9 vs 10.6 days).
Emergent 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.
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