Cost and Clinical Impact of Isolated, Individual Complications in Vascular Surgery Patients
Matthew Aizpuru, BA, Kevin X. Farley, BS, Eric R. Wagner, MD, Luke P. Brewster, MD, William D. Jordan, Jr., MD, Robert S. Crawford, MD.
Emory University, Atlanta, GA, USA.
Objective: To our knowledge, the economic impact of individual vascular surgery complications has not been defined. This study aims to identify the clinical and economic impact of relevant complications in vascular surgery patients.
Methods: 3,680,145 patients with a primary vascular surgery procedure code were identified in the National Inpatient Sample (2010-2015). Patients with an isolated, individual complication were matched using coarsened exact matching to patients with no complications. Linear regression and binomial logistic regression were performed to control for hospital-level confounders and describe the effects of isolated complications.
Results: 868,688 (24%) had an individual, isolated complication and 2,096,667 (57%) had no complications. The most common complications were AKI (4.9%), stroke (4.8%) and DVT (3.4%). 14/15 complications were associated with an increased risk of non-home discharge, ranging from ischemic bowel (OR=1.3,p<.001) to stroke (OR=5.9,p<.001). Complications with the highest increase in mortality risk were stroke (OR=9.9,p<.001), ischemic bowel (OR=8.8, p<.001) and spinal cord ischemia (OR=8.4,p<.001). LOS increased with all complications, ranging from DVT (+1.2 days, p<.001) to Clostridium difficile infection (+5.9 days,p<.001). Cost increased with 14/15 complications. The costliest complications were pneumonia (+$12,518,p<.001), septicemia (+$10,724, p<.001) and C. difficile infection (+$10,603, p<.001) (Fig.).
Conclusions:
This study quantifies the influence of individual, isolated complications on cost and clinical outcomes in vascular surgery patients. In this cohort, cost was heavily influenced by length of stay, and was most prominent with infectious etiologies. Quality improvement initiatives intending to curb costs should aim at infection control strategies as a principal target.
Figure. Mean Difference In Cost For Isolated Complications 
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