BACKGROUND: Denial of ruptured abdominal aortic aneurysm (RAAA) repair has been advocated based upon historically poor surgical outcome and a perceived lack of cost effectiveness. Although the repair intuitively seems expensive, the actual cost of care, adequacy of reimbursement, and cost per additional life-year gained for RAAA repair are poorly defined. PATIENTS AND METHODS: Retrospective clinical and financial chart review of 119 consecutive patients undergoing operation for RAAA from 1986 to 1993. RESULTS: Overall in-hospital mortality was 45%. Mean institutional charge per patient in 1993 dollars was $40,763 (range $4,473 to $284,374), with an actual mean cost for service of $22,420 and an average reimbursement of $21,360, resulting in a loss of $1,060 per patient. Losses were higher in Medicare patients. Survivors (n = 65) had an average length of stay of 20 days, cost $41,045 each, and incurred an institutional loss of $298,405. Mean cost per additional (adjusted) life-year was $3,953. One-, 3-, and 5-year survival rates following hospital discharge were 97%, 85%, and 77%, respectively. CONCLUSIONS: Emergency repair of RAAA is relatively inexpensive when compared to other commonly used health maintenance protocols and effectively restores survivors to their former health. Since no clinical or physiologic parameter can predict poor outcome, operative intervention should not be denied.
BACKGROUND:Denial of ruptured abdominal aortic aneurysm (RAAA) repair has been advocated based upon historically poor surgical outcome and a perceived lack of cost effectiveness. Although the repair intuitively seems expensive, the actual cost of care, adequacy of reimbursement, and cost per additional life-year gained for RAAA repair are poorly defined. PATIENTS AND METHODS: Retrospective clinical and financial chart review of 119 consecutive patients undergoing operation for RAAA from 1986 to 1993. RESULTS: Overall in-hospital mortality was 45%. Mean institutional charge per patient in 1993 dollars was $40,763 (range $4,473 to $284,374), with an actual mean cost for service of $22,420 and an average reimbursement of $21,360, resulting in a loss of $1,060 per patient. Losses were higher in Medicare patients. Survivors (n = 65) had an average length of stay of 20 days, cost $41,045 each, and incurred an institutional loss of $298,405. Mean cost per additional (adjusted) life-year was $3,953. One-, 3-, and 5-year survival rates following hospital discharge were 97%, 85%, and 77%, respectively. CONCLUSIONS: Emergency repair of RAAA is relatively inexpensive when compared to other commonly used health maintenance protocols and effectively restores survivors to their former health. Since no clinical or physiologic parameter can predict poor outcome, operative intervention should not be denied.
Authors: Florian Dick; Véronique Grobéty; Franz F Immer; Dai Do Do; Hannu Savolainen; Thierry P Carrel; Jürg Schmidli Journal: World J Surg Date: 2008-06 Impact factor: 3.352