Cost-identification analysis of revascularization procedures on patients with peripheral arterial occlusive disease

Objective: To determine average total in-hospital costs of various revascularization procedures for peripheral arterial occlusive disease; to examine the effect of procedure-related complications and patient characteristics on these costs; and to examine whether costs have changed over time. Methods: We collected cost data on all admissions involving one revascularization procedure for peripheral arterial occlusive disease at the Brigham and Women's hospital from 1990 through 1995 (n = 583). The main outcome measures were total costs per admission in 1995 US dollars and length of stay in days. Results: For each of 12 different procedures identified, total costs per admission varied considerably. Multiple linear regression analysis was performed to determine the effect of local and systemic complications and of patient characteristics on total in-hospital costs per admission. The additional cost incurred for fatal systemic complications was $11,675 (P =.004) and for nonfatal systemic complications was $9345 (P <.001). The results demonstrated significant additional costs with management of critical ischemia versus intermittent claudication ($4478, P <.001), presence of coronary artery disease ($1287, P =.05), female sex ($1461, P =.03), and advanced age ($1345, P=.02). No statistically significant changes over time were demonstrated. Conclusion: Total in-hospital costs per admission for peripheral revascularization procedures are highly variable and significantly increased by procedure-related complications, advanced age, female sex, management of critical ischemia, and presence of coronary artery disease.