P135. Factors Associated with High Cost in Type A Aortic Dissection Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
East Carolina University
Winterville, NC
United States - Contact Me
Brandon Peine is a general surgery resident completing a dedicated research year at East Carolina University. He graduated from medical school at Texas A&M College of Medicine and was raised in San Antonio, TX. He is pursuing a career in cardiothoracic surgery and will be applying for CT surgery residency later this year.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective
Patients presenting with acute type A aortic dissection require urgent, resource-intensive interventions, and there is significant variation in cost of caring for these patients. The purpose of this study was to identify the preoperative and operative factors that contribute to high healthcare costs in patients undergoing surgical management for type A aortic dissection.
Methods
All patients at a single institution who underwent urgent or emergent operative repair of type A aortic dissection from 2017-2022 were evaluated for study inclusion. One patient with iatrogenic dissection and five patients who died within two days following surgery were excluded. Data were obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery database and hospital financial records. Patients were grouped by total index encounter cost: with the high cost group consisting of patients with costs >70th percentile and the standard cost group consisting of patients with costs ≤70th percentile. Detailed cost data allowed for classification of costs into exclusive categories including operating room costs, intensive care unit costs, room charges, etc. Patient demographics and comorbidities, disease presentation factors, operative characteristics, and clinical outcomes were compared between groups using univariate and multivariable logistic regression analyses. P-values less than 0.05 were considered statistically significant.
Results
A total of 105 patients were included in this study, 32 in the high cost group and 73 in the standard cost group. The median total encounter cost was $46,234 in the standard cost group and $132,084 in the high cost group. See Figure 1 for a breakdown of costs by category for each group. Factors at presentation that were associated with high cost were male sex (OR 4.3 [95% CI 1.3, 14.8]), aortic root involvement requiring Bentall procedure (OR 5.9 [95% CI 1.6, 21.8]), and aortic arch involvement requiring total arch repair (OR 8.4 [95% CI 2.0, 35.7]). Malperfusion, rupture, and lower extremity neurologic deficits were not associated with increased cost. See Table 1 for all patient presentation factors. Unsurprisingly, patients in the high cost group were more likely to have a complex operative experience, including increased blood product usage, longer operative times, and increased operating room costs. High cost was also associated with postoperative complications including stroke, acute kidney injury, unplanned reoperation, and operative mortality. Post-discharge costs are also expected to be higher as high cost patients were significantly more likely to be discharged to a rehabilitation facility compared with standard cost patients.
Conclusions
Management of acute type A aortic dissection requires extensive resources, often associated with high cost. Males and patients requiring aortic root or aortic arch procedures are associated with the highest cost. Surprisingly, presenting with malperfusion, rupture, or lower extremity neurological deficits was not associated with increased cost. While more extensive repair is sometimes necessary in acute type A dissection, based on this study, it appears financially and clinically beneficial to limit surgery to relatively more straightforward procedures such as an ascending aorta/aortic hemiarch repair whenever possible. Further investigation using a larger, national patient database will be necessary to better understand this relationship.
Authors
Brandon Peine (1), Yuanyuan Fu (2), William Irish (2), Linda Kindell (1), Shahab Akhter (1), Benjamin Degner (1)
Institutions
(1) Dept. of Cardiovascular Sciences, East Carolina University, Greenville, NC, (2) Dept. of Surgery, East Carolina University, Greenville, NC
Patients presenting with acute type A aortic dissection require urgent, resource-intensive interventions, and there is significant variation in cost of caring for these patients. The purpose of this study was to identify the preoperative and operative factors that contribute to high healthcare costs in patients undergoing surgical management for type A aortic dissection.
Methods
All patients at a single institution who underwent urgent or emergent operative repair of type A aortic dissection from 2017-2022 were evaluated for study inclusion. One patient with iatrogenic dissection and five patients who died within two days following surgery were excluded. Data were obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery database and hospital financial records. Patients were grouped by total index encounter cost: with the high cost group consisting of patients with costs >70th percentile and the standard cost group consisting of patients with costs ≤70th percentile. Detailed cost data allowed for classification of costs into exclusive categories including operating room costs, intensive care unit costs, room charges, etc. Patient demographics and comorbidities, disease presentation factors, operative characteristics, and clinical outcomes were compared between groups using univariate and multivariable logistic regression analyses. P-values less than 0.05 were considered statistically significant.
Results
A total of 105 patients were included in this study, 32 in the high cost group and 73 in the standard cost group. The median total encounter cost was $46,234 in the standard cost group and $132,084 in the high cost group. See Figure 1 for a breakdown of costs by category for each group. Factors at presentation that were associated with high cost were male sex (OR 4.3 [95% CI 1.3, 14.8]), aortic root involvement requiring Bentall procedure (OR 5.9 [95% CI 1.6, 21.8]), and aortic arch involvement requiring total arch repair (OR 8.4 [95% CI 2.0, 35.7]). Malperfusion, rupture, and lower extremity neurologic deficits were not associated with increased cost. See Table 1 for all patient presentation factors. Unsurprisingly, patients in the high cost group were more likely to have a complex operative experience, including increased blood product usage, longer operative times, and increased operating room costs. High cost was also associated with postoperative complications including stroke, acute kidney injury, unplanned reoperation, and operative mortality. Post-discharge costs are also expected to be higher as high cost patients were significantly more likely to be discharged to a rehabilitation facility compared with standard cost patients.
Conclusions
Management of acute type A aortic dissection requires extensive resources, often associated with high cost. Males and patients requiring aortic root or aortic arch procedures are associated with the highest cost. Surprisingly, presenting with malperfusion, rupture, or lower extremity neurological deficits was not associated with increased cost. While more extensive repair is sometimes necessary in acute type A dissection, based on this study, it appears financially and clinically beneficial to limit surgery to relatively more straightforward procedures such as an ascending aorta/aortic hemiarch repair whenever possible. Further investigation using a larger, national patient database will be necessary to better understand this relationship.
Authors
Brandon Peine (1), Yuanyuan Fu (2), William Irish (2), Linda Kindell (1), Shahab Akhter (1), Benjamin Degner (1)
Institutions
(1) Dept. of Cardiovascular Sciences, East Carolina University, Greenville, NC, (2) Dept. of Surgery, East Carolina University, Greenville, NC
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.