Surgonomics: The Costs of Ruptured Abdominal Aortic Aneurysm

Surgical care costs continue to rise at a rate greater than overall U.S. eco nomic growth. Government and industry have vowed to slow the growth of health care spending. Prospective payment systems using the Diagnostic Related Group (DRG) mechanism are being phased in for payment of in-patient hospital care. One expected effect of the DRG payment scheme is a more careful finan cial analysis of the components of surgical care. The purposes of this study were to examine a vascular procedure, ruptured abdominal aortic aneurysm (RAAA), performed at a large teaching hospital during a ten-year period; to characterize patients by cost (hospital charges ex clusive of physician fees) and outcome; and to test the hypothesis that an IDEN TIFIER, here the presence or absence and duration of hypotension (less than 90 mm Hg systolic), could predict differences in cost and outcome. The results, in conjunction with historic data, were used to quantify aggregate hospital ex penditures for this condition by survivor and the identifier. The results indicate: (1) mortality is higher for the hypotensive patient than for the normotensive patient (p < 0.05) and is related to the duration of hypoten sion ; (2) lowest mean charges per patient were in the hypotensive more than thirty minutes group ($5,587) followed by normotensive ($28,298), then hypo tensive less than thirty minutes ($43,876); and (3) the mean charges for each survivor were $42,447 for normotensive patients versus $107,572 for hypoten sive patients. These data suggest that the hypotensive identifier may predict: (a) lower charges per patient in one group (ie, hypotensive more than 30 minutes), since this group tends to have a rapidly fatal outcome; (b) increased charges per survivor for all hypotensive patients; and (c) higher mortality for RAAA. Ag gregate annual expenditures (hospital charges) for RAAA in the United States using our model were $167,517,000 in 1983; however, the aggregate expendi tures necessary to yield 609 survivors annually with RAAA and hypotension less than thirty minutes were $30,671,806 (ie, $50,364 per survivor), whereas the aggregate annual expenditures to yield 202 survivors with RAAA and hypoten sion more than thirty minutes were $56,712,257 (ie, $280,753 per survivor).