Rinaldo Lorenzo, Brinjikji Waleed, Cloft Harry, DeMartino Randall R, Lanzino Giuseppe
Department of Neurosurgery, Mayo Clinic, Rochester, Minn.
Department of Radiology, Mayo Clinic, Rochester, Minn.
J Vasc Surg. 2017 Sep;66(3):786-793. doi: 10.1016/j.jvs.2017.03.433. Epub 2017 May 27.
We aimed to identify factors associated with cost of carotid artery stenting (CAS).
Patient and hospital characteristics affecting cost of admission for CAS were identified using the Vizient national database of hospital-reported outcomes. Patients who underwent CAS for either asymptomatic or symptomatic carotid stenosis were identified using surgical Medicare Severity-Diagnosis Related Groups and appropriate International Classification of Diseases, Ninth Revision and Tenth Revision codes.
There were 166 hospitals that reported outcomes from 7369 inpatient admissions for CAS. Each institution reported a mean value for cost related to patient care per admission for CAS; the average cost across all reporting institutions was $12,834.14 (standard error of the mean [SEM], 492.88). Institutions in the lowest 25th percentile with respect to frequency of intensive care unit admission after CAS had lower cost of admission than institutions above the 75th percentile ($10,971.30 [SEM, 460.67] vs $14,992.90 [964.29]; P = .002), without any differences in incidence of stroke during admission (2.2% [SEM, 0.3] vs 2.0% [0.4]; P = .877) or 30-day readmission (1.9% [SEM, 0.4] vs 2.5 [0.6]; P = .329). Admissions for patients with symptomatic stenosis were more expensive than those with asymptomatic stenosis ($20,462.10 [SEM, 819.93] vs $11,285.20 [347.11]; P < .001). Obesity was also associated with greater costs of admission ($14,176.20 [SEM, 597.13] vs $12,287.10 [395.73]; P < .001).
Admission to an intensive care unit, symptomatic stenosis, and obesity were associated with increased costs in patients undergoing CAS. These data may aid in identifying opportunities to improve the cost-effectiveness of this procedure.
我们旨在确定与颈动脉支架置入术（CAS）费用相关的因素。
利用Vizient全国医院报告结局数据库，确定影响CAS住院费用的患者和医院特征。使用手术医疗保险严重程度诊断相关组以及适当的国际疾病分类第九版和第十版编码，识别因无症状或有症状颈动脉狭窄而接受CAS的患者。
有166家医院报告了7369例CAS住院患者的结局。每家机构报告了每次CAS住院患者护理相关费用的平均值；所有报告机构的平均费用为12,834.14美元（均值标准误[SEM]，492.88）。CAS后重症监护病房入住频率处于最低第25百分位的机构，其住院费用低于第75百分位以上的机构（10,971.30美元[SEM，460.67]对14,992.90美元[964.29]；P = .002），住院期间中风发生率（2.2%[SEM，0.3]对2.0%[0.4]；P = .877）或30天再入院率（1.9%[SEM，0.4]对2.5[0.6]；P = .329）无差异。有症状狭窄患者的住院费用高于无症状狭窄患者（20,462.10美元[SEM，819.93]对11,285.20美元[347.11]；P < .001）。肥胖也与更高的住院费用相关（14,176.20美元[SEM，597.13]对12,287.10美元[395.73]；P < .001）。
入住重症监护病房、有症状狭窄和肥胖与接受CAS的患者费用增加相关。这些数据可能有助于确定提高该手术成本效益的机会。
