title: Preventable Complications Driving Rising Costs in Management of Patients with Critical Limb Ischemia.
abstract: BACKGROUND
  This study aimed to identify factors that drive increasing health-care costs associated with the management of critical limb ischemia in elective inpatients.
  
  
  METHODS
  Patients with a primary diagnosis code of critical limb ischemia (CLI) were identified from the 2001-2011 Nationwide Inpatient Sample. Demographics, CLI management, comorbidities, complications (bleeding, surgical site infection [SSI]), length of stay, and median in-hospital costs were reviewed. Statistical analysis was completed using Students' t-test and Mann-Kendall trend analysis. Costs are reported in 2011 US dollars corrected using the consumer price index.
  
  
  RESULTS
  From 2001 to 2011, there were a total of 451,823 patients who underwent open elective revascularization as inpatients for CLI. Costs to treat CLI increased by 63% ($12,560 in 2001 to $20,517 in 2011, P < 0.001 in trend analysis). Endovascular interventions were 20% more expensive compared with open surgery ($19,566 vs. $16,337, P < 0.001). Age, gender, and insurance status did not affect the cost of care. From 2001 to 2011, the number of patient comorbidities (7.56-12.40) and percentage of endovascular cases (13.4% to 27.4%) increased, accounting for a 6% annual increase in total cost despite decreased median length of stay (6 to 5 days). Patients who developed SSI had total costs 83% greater than patients without SSIs ($30,949 vs. $16,939; P < 0.001). Patients who developed bleeding complications had total costs 41% greater than nonbleeding patients ($23,779 vs. $16,821, P < 0.001). Overall, there was a 32% reduction in SSI rates but unchanged rates of bleeding complications during this period.
  
  
  CONCLUSIONS
  The cost of CLI treatment is increasing and driven by rising endovascular use, SSI, and bleeding in the in-patient population. Further efforts to reduce complications in this patient population may contribute to a reduction in health care-associated costs of treating CLI.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: andua@mcw.edu.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: Department of Vascular Surgery, Southern Illinois University, Springfield, IL.
authors.forename: Sapan S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Department of General Internal Medicine, North Shore Long Island Jewish Health System, New Hyde Park, NY.
authors.forename: Bhavin
authors.initials: B
authors.lastname: Patel
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Seabrook
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Kellie R
authors.initials: KR
authors.lastname: Brown
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Brian
authors.initials: B
authors.lastname: Lewis
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Rossi
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Michael
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Cheong J
authors.initials: CJ
authors.lastname: Lee
mesh_terms: D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D005260:Female; D017721:Hospital Costs / Q000639:trends; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D008297:Male; D019106:Postoperative Hemorrhage / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics* / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000639:trends