Division of Vascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Division of Vascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Vasc Surg. 2020 Jul;72(1):250-258.e8. doi: 10.1016/j.jvs.2019.09.054. Epub 2020 Jan 21.
Inpatient treatment of peripheral artery disease (PAD) is more than six times as costly as that of the general inpatient population. Our objective was to describe factors associated with hospital cost for patients admitted for PAD, the characteristics of high-cost patients, and their outcomes including amputations and death.
We performed a retrospective cohort study of admitted patients receiving a procedure for PAD at The Ottawa Hospital between 2007 and 2016. Demographics, comorbidity, inpatient events, and hospital cost data during the index admission were collected. We defined high-cost patients as those whose total costs of index admission were in the tenth percentile and above. Features associated with high-cost status were examined using logistic regression with elastic net regularization. We used generalized linear models to examine overall drivers of cost.
We identified 3084 eligible patients, incurring $72.2 million in hospital costs. The mean cost of the most expensive 10% of patients was $88,076 (standard deviation, $54,720), more than five times the mean cost of $16,217 (standard deviation, $10,322) for nonhigh-cost patients. High-cost patients were more likely to present urgently (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.16-2.25; P < .01). After adjustment for preadmission factors, high-cost patients were more likely to have experienced an adverse patient safety incident (OR, 13.49; 95% CI, 6.97-24.8; P < .01), amputation (OR, 2.79; 95% CI, 1.68-4.49; P <.01), intensive care unit admission (OR, 6.42; 95% CI, 3.62-10.2; P < .01), and disposition barriers requiring alternate level of care status (OR, 10.44; 95% CI, 6.42-15.2; P < .01). The high-cost group was more likely to have received hybrid revascularization (OR, 7.07; 95% CI, 3.34-13.6; P < .01). High-cost patients had higher than predicted in-hospital mortality (18% vs 9.2% predicted) compared with the low-cost group (3.0% vs 2.7%; P < .001), and fewer than half of high-cost patients were discharged home.
Providing hospital care for the top 10% most expensive patients in our cohort was more than five times as costly per patient than providing care for the nonhigh-cost patients. Whereas pre-existing factors may predispose a patient to require expensive care, there are potentially modifiable factors during the admission that could reduce costs of these patients.
外周动脉疾病（PAD）患者的住院治疗费用是普通住院患者的 6 倍以上。我们的目的是描述与 PAD 患者住院费用相关的因素、高费用患者的特征及其结局，包括截肢和死亡。
我们对 2007 年至 2016 年在渥太华医院接受 PAD 治疗的住院患者进行了回顾性队列研究。收集了患者的人口统计学、合并症、住院期间的事件以及入院期间的费用数据。我们将总费用排在第 10 百分位及以上的患者定义为高费用患者。使用具有弹性网络正则化的逻辑回归检查与高费用状态相关的特征。我们使用广义线性模型来检查费用的总体驱动因素。
我们确定了 3084 名符合条件的患者，其住院费用为 7220 万美元。最昂贵的 10%患者的平均费用为 88076 美元（标准差为 54720 美元），是非高费用患者平均费用 16217 美元（标准差为 10322 美元）的五倍多。高费用患者更有可能紧急就诊（优势比[OR]，1.63；95%置信区间[CI]，1.16-2.25；P<.01）。在校正了入院前因素后，高费用患者更有可能经历不良的患者安全事件（OR，13.49；95%CI，6.97-24.8；P<.01）、截肢（OR，2.79；95%CI，1.68-4.49；P<.01）、入住重症监护病房（OR，6.42；95%CI，3.62-10.2；P<.01）和需要替代护理水平的出院障碍（OR，10.44；95%CI，6.42-15.2；P<.01）。高费用组更有可能接受混合血运重建（OR，7.07；95%CI，3.34-13.6；P<.01）。与低费用组相比（预测死亡率为 3.0%，实际死亡率为 2.7%），高费用组的住院死亡率更高（预测死亡率为 18%）（P<.001），且不到一半的高费用患者出院回家。
为我们队列中前 10%最昂贵的患者提供住院治疗的费用是为非高费用患者提供治疗费用的 5 倍以上。尽管患者可能存在导致昂贵治疗的固有因素，但在入院期间仍存在一些潜在的可改变的因素，可以降低这些患者的费用。
