Treatment for peripheral arterial obstructive disease: An appraisal of the economic outcome of complications

Objective: This study determined the average estimated total costs after treatment for peripheral arterial occlusive disease (PAOD) and evaluated the effect of postoperative complications and their consequences for the total Costs. Methods. Cost data on all admissions involving treatment for PAOD from January 2007 until July 2007 were collected. A prospective analysis was made using the patient-related risk factor and comorbidity (Society for Vascular Surgery/International Society of Cardiovascular Surgeons) classification, primary and secondary treatment, and prospectively registered complications. At admission, patients without complications were placed in group A, and those with complications were in group B. Prospectively registered complications were divided into patient management (I), surgical technique (II), patient's disease (III), and outside surgical department (IV). The consequences of these were divided into minor complication, no long-term consequence (1A), additional medication or transfusion (1B), surgical reoperation (2A), prolonged hospital stay (2B), irreversible physical damage (3), and death (4). The main outcome measures were total costs of patients and costs per patient (PP), with or without the presence of complications, cost of complications and costs per complication (PC), and the costs of their consequences calculated in euros (epsilon). Results. Ninety patients (mean age, 71.4 years; 59% men) were included. Group B patients had a significantly higher American Society of Anesthesiologists (4) and Fontaine (3) classification and more secondary procedures. Total costs were epsilon 1,716,852: group A, epsilon 512,811 (PP epsilon 12,820); and group B, epsilon 1,204,042 (PP epsilon 24,081). The costs of the 115 complications were epsilon 568,500 (PC is an element of 4943). Split by the cause of the complication, costs were I, epsilon 95,924 (PC epsilon 2998); II, epsilon 163,137 (PC epsilon 8157); III, epsilon 289,578 (PC epsilon 5171); and IV, epsilon 19,861 (PC epsilon 2837). The increase of costs in group B was mainly caused by additional medication or transfusion (1B) epsilon 348,293 (61.3%), a surgical reoperation (2A) epsilon 118,054 (20.8%), or prolonged hospital stay (2B) epsilon 60,451 (10.6%). Patients who died caused 23% of the total costs. Conclusion: Complications cause an increase of the average estimated total costs in the treatment for peripheral arterial occlusive disease and are responsible for 33% of these total costs. The most expensive complications were errors in surgical technique and patient's disease, resulting in surgical reoperation or additional medication, or both, or transfusion, the two most expensive consequences.