Comparison of costs of staged versus simultaneous lower extremity arterial hybrid procedures

Ebaugh, James L.; Gagnon, David; Owens, Christopher D.; Conte, Michael S.; Raffetto, Joseph D.

doi:10.1016/j.amjsurg.2008.08.003

« Previous Next »The American Journal of Surgery
Volume 196, Issue 5 , Pages 634-640, November 2008

Comparison of costs of staged versus simultaneous lower extremity arterial hybrid procedures

Presented at the Association of VA Surgeons 32nd Annual Meeting, Dallas, TX, May 4–6, 2008.

James L. Ebaugh, M.D., M.P.H.
- Boston VA Healthcare System, Surgical Service (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Corresponding author. Tel.: +1-857-203-6200; fax: +1-857-203-5738
David Gagnon, M.D., Ph.D., M.P.H.
- Massachusetts Veterans Epidemiology Research and Information Center, VA Cooperative Studies Program, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
Christopher D. Owens, M.D.
- Boston VA Healthcare System, Surgical Service (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Michael S. Conte, M.D.
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Joseph D. Raffetto, M.D.
- Boston VA Healthcare System, Surgical Service (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

Received 21 May 2008; received in revised form 11 August 2008

Abstract

Background

Hybrid procedures combine endovascular and open surgical techniques. We examined utilization rates and ways of performing them more efficiently.

Methods

Hybrids were selected using codes for femoral endarterectomy, infrainguinal, or aorto-iliac-femoral bypass and angioplasty from Nationwide Inpatient Sample (NIS) data, then categorized as staged, or performed on the same day. Outcomes included utilization rates, total hospital charges, and length of stay (LOS). Confounders of charges and LOS were identified and excluded from final comparisons.

Results

Utilization increased 7% from 2000 to 2004. Univariate associations linked staging to variables included in linear regressions for hospital charges and LOS. Excluding identified confounders from the final subgroup analysis still showed large differences in charges (same-day = $34,206, staged = $60,087) and LOS (same-day = 3 days, staged = 7 days).

Conclusions

Utilization of hybrids is increasing. Performing hybrids on the same day, if possible, greatly reduces hospital charges and LOS, emphasizing preadmission planning and simultaneous coordination of both portions.

Keywords: Hybrid, Healthcare costs, Utilization, Vascular surgery, Percutaneous transluminal angioplasty and stent, Lower extremity bypass