Comparative effectiveness and efficiency in peripheral vascular surgery.

Abstract:

BACKGROUND:Elective peripheral vascular surgery provides quality outcomes that are of great benefit to patients, but have complications that result in severe morbidity and excessive costs. METHODS:We studied elective carotid endarterectomy, aortofemoral bypass/aortic aneurysm repairs, and femoral-distal bypass surgeries among hospitals(N ≥ 20 cases) from 2002 to 2005 from the national Inpatient Sample of the Healthcare Cost and Utilization project. Adverse outcomes, mortality, and cost models were developed. Outlier hospitals were defined for excessive adverse outcomes (P < .005) and excess cost (P < .0005). RESULTS:There were 43,700 carotid endarterectomy patients from 447 hospitals, 9,090 aortofemoral bypass/aortic aneurysm patients from 187 hospitals, and 14,453 femoral-distal bypass patients from 243 hospitals. Approximately 3% of hospitals were quality outliers, and 8% to 24% of hospitals were efficiency outliers by procedure. CONCLUSIONS:Comparative effectiveness and efficiency modeling at the hospital level shows inefficiency and is responsible for 90% of excess costs. Overall reduced complication rates will further enhance cost reductions.

journal_name

Am J Surg

authors

Fry DE,Pine M,Jones BL,Meimban RJ

doi

10.1016/j.amjsurg.2010.08.025

subject

Has Abstract

pub_date

2011-03-01 00:00:00

pages

363-7; discussion 367-8

issue

3

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(10)00755-5

journal_volume

201

pub_type

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