title: Institutional Cost of Unplanned 30-Day Readmission Following Open and Endovascular Surgery.
abstract: BACKGROUND
  Vascular surgical patients have a high rate of readmission, and the cost of readmission for these patients has not been described. Herein, we characterize and compare institutional index hospitalization and 30-day readmission cost following open and endovascular vascular procedures.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was used to identify inpatient open and endovascular procedures at a single institution, from January 2011 through June 2012. Variable and fixed costs for index hospitalization and unplanned 30-day readmissions were obtained using SAP BusinessObjects. Patient characteristics and outcome variables were analyzed using Student t tests or Wilcoxon rank-sum nonparametric tests for continuous variables and Fisher exact tests for categorical variables.
  
  
  RESULTS
  One thousand twenty-six inpatient procedures were included in the analysis. There were 605 (59%) open and 421 (41%) endovascular procedures with a 30-day unplanned readmission rate of 16.9% and 17.8%, respectively (P = .679). The mean index hospitalization costs for open and endovascular procedures were US$27 653 and US$23 999, respectively (P = .146). The mean costs for 30-day unplanned readmission for open and endovascular procedures were US$19 117 and US$17 887, respectively (P = .635). Among open procedures, the mean cost for patients not readmitted was US$28 321 compared to US$31 115 for those readmitted (P = .003). Among endovascular procedures, the mean cost for patients not readmitted was US$26 908 compared to US$32 262 for those readmitted (P = .028).
  
  
  CONCLUSIONS
  The cost of index hospitalization and 30-day unplanned readmission are similar for open and endovascular procedures. Readmitted patients had a higher mean index hospitalization cost irrespective of open or endovascular procedure.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, IN, USA.
authors.forename: Adam S A
authors.initials: AS
authors.lastname: Gracon
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, IN, USA.
authors.forename: Tiffany W
authors.initials: TW
authors.lastname: Liang
authors.affiliation: Indiana University School of Medicine, IN, USA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Easterday
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, IN, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, IN, USA.
authors.forename: James
authors.initials: J
authors.lastname: Butler
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, IN, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Slaven
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, IN, USA Division of Vascular Surgery, Indiana University School of Medicine, IN, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Lemmon
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, IN, USA Division of Vascular Surgery, Indiana University School of Medicine, IN, USA rmotagan@iupui.edu.
authors.forename: Raghu L
authors.initials: RL
authors.lastname: Motaganahalli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics*; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015233:Models, Statistical; D010359:Patient Readmission / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Affordable Care Act; hospital cost; readmission; vascular surgery