Specialized Vascular Floors After Open Aortic Surgery: Cost Containment While Preserving Quality Outcomes

Vandy, Frank C.; Campbell, Dani N.; Eliassen, Anna M.; Rectenwald, John; Eliason, Jonathan L.; Escobar, Guillermo A.; Upchurch, Gilbert R.

doi:10.1016/j.avsg.2012.09.002

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…26 Reducing the total volume of contrast and even using alternative contrast agents, such as CO 2 , will also help prevent AKI that frequently results in prolonged LOS and increased cost. 24,27,28 …”

Section: Discussionmentioning

confidence: 99%

“…2 Postoperative admission to the ICU is not always necessary; alternatives, such as specialized vascular floors, could offer cost containment while preserving quality outcomes. 28 In addition, these patients have a small physiologic window and do not respond well to changes in their hemodynamic state; therefore, hospital-acquired infections, disruption of their complex medication regimens, and invasive procedures place these patients at great risk for increased mortality with prolonged hospitalization. 2 …”

Section: Discussionmentioning

confidence: 99%

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Targets to prevent prolonged length of stay after endovascular aortic repair

Mehaffey

LaPar

Tracci

et al. 2015

Journal of Vascular Surgery

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Objective Endovascular aneurysm repair (EVAR) is a commonly performed vascular operation. Yet, postoperative length of stay (LOS) varies greatly, even within institutions. The present study reviewed the morbidity, mortality, and the financial effect of increased LOS to establish modifiable factors associated with prolonged hospital LOS, with the goal of improving quality. Methods The Society for Vascular Surgery Vascular Quality Initiative database was used to identify all patients under-going primary, elective EVAR at a single institution between January 1, 2011, and May 28, 2014. Preoperative patient characteristics, intraoperative details, postoperative factors, long-term outcomes, and cost data were reviewed using an Institutional Review Board-approved prospectively collected database. Multivariate analysis was used to determine statistical difference between patients with LOS ≤2 days and >2 days. Results Complete 30-day variable and cost data were available for 138 patients with an average follow-up of 12 months; of these, 46 (33%) had a LOS >2 days. Variables determined to be statistically significant predictors of prolonged LOS included aneurysm diameter (P = .03), American Society of Anesthesiologists Physical Status Classification score (P < .001), thromboembolectomy (P = .01), and increased postoperative cardiac (P < .001) and renal (P = .01) complications. Specifically, modifiable risk factors that contributed to increased LOS included performance of a concomitant procedure (P < .001), increased volume of iodinated contrast (P = .05), increased volume of intraoperative crystalloid (P = .05), placement in an intensive care unit (P < .001), return to the operating room (P < .001), and the use of vasoactive medications (P < .001). Hospital charges ($102,000 ± $41,000 vs $180,000 ± $73,000; P = .01) and costs ($27,000 ± $10,000 vs $45,000 ± $19,000 P = .01) were significantly higher in patients with prolonged LOS; however, there was no difference in physician charges ($8000 ± $5700 vs $12,000 ± $12,000; P = .09). Increased LOS after EVAR was associated with an increase in mortality at 1 month (0% vs 4% P = .05) and 12 months (3% vs 13% P = .03). Conclusions This study highlights several modifiable risk factors leading to increased LOS after EVAR, including performance of concomitant procedures, admission to the intensive care unit, and postoperative renal and cardiac complications. Further, increased LOS was associated with increased charges, costs, morbidity, and mortality after EVAR. This study highlights specific areas of focus for decreasing LOS after EVAR and, in turn, improving quality in vascular surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Targets to prevent prolonged length of stay after endovascular aortic repair

Mehaffey

LaPar

Tracci

et al. 2015

Journal of Vascular Surgery

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The Effects of Case Timing and Care Team Composition on Hospital Operating Room Costs for Endovascular Procedures

Craven

Hirsch

et al. 2019

Annals of Vascular Surgery

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Postoperative Management of Vascular Surgery Patients and Complications

Rábai¹,

Cooper²,

Covington³

2021

Vascular Anesthesia Procedures

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Vascular surgery carries an increased risk of a variety of complications in the immediate and extended postoperative periods. Major vascular operations, such as thoracoabdominal aortic aneurysm repairs and limb revascularizations, are commonly associated with prolonged operative time, ischemic reperfusion injuries, large blood losses, and systemic inflammatory response syndrome. Additionally, vascular patients usually present with a high burden of comorbidities. These factors increase the risk of multiple organ systems failing postoperatively. Myocardial injury, postoperative pulmonary complications, acute kidney injury, and neurovascular complications are relatively common and have been shown to increase morbidity and mortality. Close monitoring and an appropriate level of care ensure a safe transition into the postoperative phase. Recent data suggest that risk stratification with modern diagnostic tools and laboratory tests using sensitive biomarkers play pivotal roles in the early detection of deteriorating organ function and initiation of timely intervention. Evidence-based postoperative management guidelines and care bundles (e.g., prehabilitation, enhanced screening for myocardial injury, lung-protective ventilator management, kidney protection strategies, and enhanced recovery protocols) show promise in preventing, mitigating, and effectively treating complications with an overarching goal of optimizing postoperative outcomes and ensuring that patients recover successfully.

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Specialized Vascular Floors After Open Aortic Surgery: Cost Containment While Preserving Quality Outcomes

Cited by 5 publications

References 14 publications

Targets to prevent prolonged length of stay after endovascular aortic repair

Targets to prevent prolonged length of stay after endovascular aortic repair

The Effects of Case Timing and Care Team Composition on Hospital Operating Room Costs for Endovascular Procedures

Postoperative Management of Vascular Surgery Patients and Complications

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