In-Hospital Cost of Abdominal Aortic Aneurysm Repair in Canada and the United States

Brox, Anya C.; Filion, Kristian B.; Zhang, Xun; Pilote, Louise; Obrand, Daniel I.; Haider, Seema; Azoulay, Arik; Eisenberg, Mark J.

doi:10.1001/archinte.163.20.2500

Cited by 24 publications

(13 citation statements)

References 20 publications

(18 reference statements)

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“…Up to 20% of patients require reintervention within 5 years, making costly long term follow up necessary 17,18. In-hospital surgical management of AAA is estimated to cost ~US$25,000 in Australia, US$16,000 in Canada and US$23,000 in the USA per individual per annum 19,20. Given the high prevalence of AAA in the elderly population, global disease management costs billions of dollars each year 2,21,22…”

Section: 0 Introductionmentioning

confidence: 99%

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

Moxon

Parr²,

Emeto³

et al. 2010

Current Problems in Cardiology

125

148

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Abdominal aortic aneurysm (AAA) remains an important cause of morbidity and mortality in elderly men, and prevalence is predicted to increase in parallel with a global ageing population. AAA is commonly asymptomatic, and in the absence of routine screening, diagnosis is usually incidental when imaging to assess unrelated medical complaints. In the absence of approved diagnostic and prognostic markers, AAAs are monitored conservatively via medical imaging until aortic diameter approaches 50-55mm and surgical repair is performed. There is currently significant interest in identifying molecular markers of diagnostic and prognostic value for AAA. Here we outline the current guidelines for AAA management, and discuss modern scientific techniques currently employed to identify improved diagnostic and prognostic markers. KeywordsAbdominal aortic aneurysm; diagnosis; prognosis; biomarker INTRODUCTIONAn abdominal aortic aneurysm (AAA) is a dilation of the infra-renal aorta, which appears to result from chronic weakening of the arterial wall, increasing the risk of fatal rupture.1 -3 AAA is also associated with an increased risk of other major cardiovascular events in aneurysmal patients. For example the UK small aneurysm trial (UKSAT), demonstrated that only 16% of deaths in patients with 40-55mm AAAs was related to AAA repair or rupture while ~50% were due to other cardiovascular causes (mainly myocardial infarction and stroke).4 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access AAA pathologyMacroscopically, an AAA can be considered a dilatation of the infrarenal aorta, giving rise to a permanent vessel diameter >30mm (typical abdominal aortic diameter ranges from 15 to 25mm). 23-27 AAA vessel dilation is commonly progressive, and is often accompanied by the formation of a laminated, non-occlusive, intraluminal thrombus.28 -29 Thrombus size and location varies between patients, and the arterial wall may be partially or completely covered by the thrombus ( Figure 1A and B). 30 The thrombus remains in permanent contact with circulating blood and is continually remodeled, 31,32 and thrombus size increases in parallel with aortic dilation. Due to constant remodeling the thrombus is a laminated structure comprising a red blood cell-rich luminal layer in contact with the flowing blood, progressing to a brown fibrinolysed layer at the aortic wall. 29 Localised hypoxia has been demonstrated in regions of the aorta covered by the thrombus and this has been suggested to contribute to physiological stresses within the arterial wall. 33 Similar to other vascular dise...

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Section: 0 Introductionmentioning

confidence: 99%

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

Moxon

Parr²,

Emeto³

et al. 2010

Current Problems in Cardiology

125

148

View full text Add to dashboard Cite

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“…Brox at al. found in their study [8] the average length of hospitalization in Canada by 1.2 day longer than in the United States (USA being in the range from 5.7 to 7.4 days, and Canada from 4.6 to 7.7 days).…”

Section: Diagnosis Of Acute Myocardial Infarction In the Czech Rementioning

confidence: 75%

“…There is relatively rich literature dealing with the cost of treatment of cardiologic diagnoses. Although each author tries to quantify the costs from a somewhat different perspective [6][7][8][9], when comparing the economic data on acute myocardial infarction found in international studies and in statistics of the Institute of Health Information and Statistics [10] with the data recorded in 50 patients with STEMI in the general University Hospital, we can find that they are quite similar.…”

Section: Discussionmentioning

confidence: 99%

“…According to Soekhlal et al [7], 67% men and 33% women were hospitalized with acute coronary syndrome in the Netherlands in 2008. Brox et al [8] studied hospitalizations with AMI in two hospitals in Canada and seven hospitals in the US in 1997, and found 72% representation of women in Canada and 64% in the US. Wang et al [9] found 74% men and 26% women in patients with AMI in the US.…”

Section: Diagnosis Of Acute Myocardial Infarction In the Czech Rementioning

confidence: 99%

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The cost of acute myocardial infarction treatment in the Czech Republic — The case of General University Hospital in Prague

Baustein

Barták

Janota

et al. 2015

2015 E-Health and Bioengineering Conference (EHB)

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The paper deals with costs of the treatment of acute myocardial infarction treated with percutaneous coronary intervention in the General University Hospital in Prague, Czech Republic in 2012. The average amount of the cost of treatment in patients with ST segment elevation myocardial infarction (STEMI) was CZK 119 600 when figured out by the bottom-up method in the hospital. According to the general Health Insurance Company, the cost of treatment of a patient during one year after his release from the medical facility amounted to CZK 84 617. Hence, the total cost of treatment in patients with STEMI, calculated for oneyear period, is CZK 204 217. A detailed specification of these figures is provided and discussed thoroughly.

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“…Total hospital costs were measured using TSI cost accounting system (Transition Systems, Inc, Boston, MA, and now Eclipsys Corporation) (16-17) at 5 out of the 6 participating sites. TSI is a hospital cost accounting software that integrate resource utilization and financial data already recorded in other hospital databases (such as billing system, payroll system, general ledger system) (17).…”

Section: Methodsmentioning

confidence: 99%

Do hospitalists affect clinical outcomes and efficiency for patients with acute upper gastrointestinal hemorrhage (UGIH)?

Vaughan-Sarrazin

Auerbach

et al. 2010

Journal of Hospital Medicine

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BACKGROUND Care by hospitalists has been associated with improved/similar clinical outcomes and efficiency. However, less is known about their effect on conditions dependent upon specialists for procedures/treatment plans. Our objective was to compare care for upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and non-hospitalists. METHODS The study included 450 UGIH patients admitted to general medical services of 6 teaching hospitals. Outcomes included in-hospital mortality and complications (i.e., recurrent bleeding, ICU-transfer, decompensation, transfusion, re-endoscopy, 30-day readmission). Efficiency was measured by hospital costs and length of stay (LOS). RESULTS Of 450 patients, 40% (177) were cared for by hospitalists with no differences between groups by endoscopic diagnosis, performance of early esophagogastroduodenoscopy (EGD), Rockall risk score, or Charlson index. Unadjusted clinical outcomes between hospitalists and non-hospitalists were similar except for 2 outcomes: patients cared for by hospitalists were more likely to receive a transfusion (74% vs. 63%; p=.02) or be re-admitted within 30-days (7.3% vs. 3.3%; p=.05). However, differences in adverse outcomes between providers were not seen after multivariable adjustments. Median LOS was similar for hospitalists and non-hospitalists (4 days; p=.69), but patients cared for by hospitalists had higher median costs ($7,359 vs. $6,181; p<.01). In multivariable analyses, LOS was similar (5.2 vs. 4.7 days; p=.15) and costs remained higher for the hospitalist-led teams (p<0.03). CONCLUSIONS Despite having similar overall outcomes and LOS, costs were higher in UGIH patients attended by hospitalists. These results suggest that the academic hospitalist model may be tempered in patients requiring specialists for procedures or management.

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In-Hospital Cost of Abdominal Aortic Aneurysm Repair in Canada and the United States

Cited by 24 publications

References 20 publications

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

The cost of acute myocardial infarction treatment in the Czech Republic — The case of General University Hospital in Prague

Do hospitalists affect clinical outcomes and efficiency for patients with acute upper gastrointestinal hemorrhage (UGIH)?

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