title: The effect of diabetes mellitus on costs and length of stay in patients with peripheral arterial disease undergoing vascular surgery.
abstract: OBJECTIVE
  To determine the impact of diabetes mellitus (DM) and other comorbidities on length of stay (LOS) and costs in patients with peripheral arterial disease (PAD) admitted to a vascular surgical unit.
  
  
  METHODS
  A retrospective study was conducted between January 2011 and July 2012 at a tertiary referral hospital in Sydney. Demographic, laboratory, and operative data were obtained from the Australasian Vascular Audit database and hospital diagnostic-related group (DRG) reports. Patients with confirmed PAD with or without DM requiring hospital admission for a diagnosis of claudication, rest pain, ulcer/gangrene, and infection that required lower limb surgical intervention were included. Associations between LOS, surgical procedure, and DRG were explored.
  
  
  RESULTS
  Five hundred and sixty-eight admissions (492 patients) were identified: 292 admissions with PAD and 276 admissions with PAD in conjunction with DM (PADDM). Mean LOS for patients with PAD was 10 ± 13.7 days compared with 15 ± 18.2 days for PADDM (p < .01; 95% confidence interval 2.7-8.0). LOS and costs were greatest in patients with PADDM undergoing major amputation (37 ± 13.7 days; US$42,236; p < .01). Analysis of variance indicated that the best predictors of LOS were the presence of DM, bypass surgery, amputation, chronic kidney disease (CKD) stage V, infection, and emergency admission. Over 18 months, the estimated total inpatient costs associated with lower limb intervention for PAD with and without DM amounted to US$7,598,597. People with DM incurred greater inpatient costs, averaging US$1,912 more per episode of admission and a total of US$528,029 over 18 months.
  
  
  CONCLUSIONS
  The impact of diabetes as a comorbid condition in patients with PAD is significant, both clinically and economically. Factors that predict increased LOS in patients with PAD are DM, bypass surgery, amputation, CKD stage V, infection, and emergency admission.
authors.affiliation: High Risk Foot Service, Liverpool Hospital, Liverpool, NSW 2170, Australia; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia. Electronic address: matthew.malone@sswahs.nsw.gov.au.
authors.forename: M
authors.initials: M
authors.lastname: Malone
authors.affiliation: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia.
authors.forename: N S
authors.initials: NS
authors.lastname: Lau
authors.affiliation: High Risk Foot Service, Liverpool Hospital, Liverpool, NSW 2170, Australia; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: White
authors.affiliation: Diabetes Foot Service, Western Health, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Novak
authors.affiliation: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Xuan
authors.affiliation: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Iliopoulos
authors.affiliation: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Crozier
authors.affiliation: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Ambulatory Care, Liverpool Hospital, Liverpool, NSW, Australia.
authors.forename: H G
authors.initials: HG
authors.lastname: Dickson
mesh_terms: D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000639:trends*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics / Q000639:trends; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000191:economics*
keywords: Diabetes mellitus; Economics; Length of stay; Lower limb; Peripheral arterial disease; Vascular surgery