Factors affecting length of hospital stay for femoropopliteal bypass. Implications of the DRGs.

We compared the length of hospitalization of 329 patients undergoing femoropopliteal bypass during 1982 with that allowed under Medicare's diagnosis-related groups (DRGs) for major reconstructive vascular surgery (DRGs 110 and 111). The mean length of stay was found to be related to the patients' age, increasing at a rate of about 1 percent per year. The site of distal anastomosis, a factor not considered in establishing the criteria for these DRGs, was also important. The lengths of stay for above-the-knee popliteal, below-the-knee popliteal, and tibioperoneal anastomoses were significantly different (F = 3.31; P less than 0.05), with lengths of stay increasing for more distal anastomoses. More distal anastomoses were also associated with increased rates of postoperative morbidity, reoperation, and mortality. Significant differences were noted among the patients treated by different surgeons, with respect to their age, the percentage with previous ipsilateral surgery, the frequency of tibial bypass, and the rates of morbidity, reoperation, and mortality. The most highly qualified surgeons dealt with the sickest patients. We conclude that the DRG system does not take account of important variables influencing the length of hospitalization for femoropopliteal bypass, that it favors younger patients undergoing proximal bypass, and that it is biased against distal bypass for limb salvage.