Chien Yi M. Png

Vascular surgeon-hospitalist comanagement improves in-hospital mortality at the expense of increased in-hospital cost

Objective: We have shown that vascular surgeon‐ hospitalist co management resulted in improved in‐hospital mortality rates. We now aim to assess the impact of the hospitalist co management service (HCS) on healthcare cost. Methods: A total of 1558 patients were divided into three cohorts and compared: 516 in 2012, 525 in 2013, and 517 in 2014. The HCS began in January 2013. Data were standardized for six vascular surgeons that were present 2012–2014. New attendings were excluded. Ten hospitalists participated. Case mix index (CMI), contribution margin, total hospital charges (THCs), length of stay (LOS), actual direct costs (ADCs), and actual variable indirect costs (AVICs) were compared. Analysis of variance with post‐hoc tests, t‐tests, and linear regressions were performed. Results: THC rose by a mean difference of

PC138 Not All Vascular Surgery Readmissions Are Created Equal

14,578.31 between 2012 and 2014 (P < .001) with a significant difference found between all groups during the study period (P = .0004). ADC increased more than AVIC; however, both significantly increased over time (P = .0002 and P = .014, respectively). A mean

Endovascular Treatment of Dialysis Access–Induced Hand Ischemia Using a Flared Stent-Graft

3326.63 increase in ADC was observed from 2012 to 2014 (P < .0001). AVIC only increased by an average

The Effect of Age on Post-EVAR Outcomes

392.86 during the study period (P = .01). This increased cost was observed in the context of a higher CMI and longer LOS. CMI increased from 2.25 in 2012 to 2.53 in 2014 (P = .006). LOS increased by a mean 1.02 days between 2012 and 2014 (P = .016), and significantly during the study period overall (P = .018). After adjusting for CMI, LOS increases by only 0.61 days between 2012 and 2014 (P = .07). In a final regression model, THC is independently predicted by comanagement, CMI, and LOS. After adjusting for CMI and LOS, the increase in THC because of comanagement (2012 vs 2014) accounts for only

An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement

4073.08 of the total increase (P < .001). During this time, 30‐day readmission rates decreased by ˜7% (P = .005), while related 30‐day readmission rates decreased by ˜2% (P = .32). Physician contribution margin remained unchanged over the 3‐year period (P = .76). The most prevalent diagnosis‐related group was consistent across all years. Variation in the principal diagnosis code was observed with the prevalence of circulatory disorders because of type II diabetes replacing atherosclerosis with gangrene as the most prevalent diagnosis in 2013 and 2014 compared with 2012. Conclusions: In‐hospital cost is significantly higher since the start of the HCS. This surge may relate to increased CMI, LOS, and improved coding. This increase in cost may be justified as we have observed sustained reduction in in‐hospital mortality and slightly improved readmission rates.

The Protective Effects of Diabetes Mellitus on Post-EVAR AAA Growth and Reinterventions

Objectives: We investigated the risk factors associated with and causes of readmission of patients following an inpatient vascular surgery stay. Methods: A total of 1000 randomly selected patients who were admitted to the vascular surgery inpatient service between 2011 and 2014 were retrospectively identified; of these, 28 patients were excluded due to missing data points. Readmissions were measured both 30 days and 1 year after discharge from the initial hospital stay. The readmissions were characterized as planned/unplanned and related/unrelated. Planned readmissions were defined as readmissions scheduled at the time of the initial admission. Related readmissions were defined as readmissions clinically related to the initial admission. Predictors for readmission were analyzed using c tests and t-tests. Differences in types of readmission were analyzed using binomial tests and c goodness of fit tests. Results: The overall all-cause 30-day readmission rate was 23.3%, and the overall all-cause 1-year readmission rate was 53.8%. Compared to nonreadmitted patients, readmitted patients were more likely to be diabetic (69%), hypertensive (92%), hyperlipidemic (66%), former or active smokers (62%), and associated with other cardiovascular comorbidities (87%; P < .01, Table I). There were no differences in age or sex between readmitted and nonreadmitted patients. Of the 30-day readmissions, related/unplanned readmissions were the most common (P < .001) and constituted 36.7% of all 30-day readmissions (Table II). Of the 1-year readmissions, unrelated/unplanned readmissions occurred most frequently (38.4%; P < .001), although related/unplanned readmissions also contributed significantly, contributing to 25.8% of all 1-year readmissions (Table II). Major causes of related/unplanned readmissions included surgical site infection, healing problems, and failure of surgery. Other top causes for readmissions included amputation, wound débridement, and angioplasty/stenting for related/planned readmissions; peripheral intervention of alternate vascular bed for unrelated/planned readmissions; and exacerbation of an acute medical comorbidity, acute infection, or acute traumatic injury for unrelated/unplanned readmissions. Conclusions: Theoretically, related/unplanned readmissions are the most preventable type. Identifying the causes of these readmissions may allow us to reduce overall readmission rates. In our cohort, between 2011 and 2014, a total of 226 patients were readmitted within 30 days of their inpatient vascular surgery stay. If the 83 (36.7%) related/unplanned readmissions could have been prevented, the overall 30-day readmission rate could have been reduced from 23.3% to as low as 14.7%.

PC188 Outcomes of Iliac Vein Stenting in Proximal Venous Outflow Obstruction

Purpose: To report an investigation of a purely endovascular procedure to address access-induced hand ischemia in dialysis patients. Case Report: Two dialysis patients presented with stage III steal syndrome consisting of severe pain and numbness in their fingers. Preoperative fistulograms distal to the anastomosis showed alternating antegrade and retrograde flow. Under ultrasound guidance, the fistula was accessed and a 4-F micropuncture sheath placed. An angled guidewire was then advanced proximally into the brachial artery. A 6-F short sheath with marker was placed followed by a 4-F straight guide catheter inserted into the proximal brachial artery. A 9-F Flair endovascular stent-graft was advanced over a 0.035-inch stiff angled Glidewire into the fistula just distal to the arterial anastomosis and deployed. Postoperatively, pain and numbness resolved in both patients immediately. Postoperative fistulograms documented antegrade flow. Access flow velocity readings decreased significantly and pulse oximetry readings increased significantly in both patients, who were followed for >6 months with no reported complications. Conclusion: These 2 cases suggest that this endovascular approach to access-induced hand ischemia may be a viable alternative to open/hybrid surgery.