Lazar J. Greenfield

Classification and Grading of Chronic Venous Disease in the Lower Limbs-A Consensus Statement-

Classification and grading of chronic venous disease in the lower limbs : A consensus statement

Natural history and management of iliac aneurysms.

Fifty-five patients with 72 aneurysms of the iliac vessels were evaluated retrospectively during a 12-year period (1972 to 1985). Atherosclerotic vascular disease was found in all aneurysms. Marked male predominance (5:1) and advanced age (mean 74.6 years) characterized this population group. Two thirds of them harbored multiple aneurysms and isolated aneurysms were found primarily to involve the internal iliac artery (12 of 18 patients). Although symptomatic presentation varied with anatomic location and presence of rupture, most patients were either asymptomatic (45%) or had such nonspecific complaints (11%) that diagnosis was often delayed or erroneous. A mass detected during abdominal, rectal, or vaginal examination was found in 39 patients (70%). Aneurysm size ranged from 2.5 to 18 cm (mean 5.5 cm) for the entire group. Internal iliac aneurysms tended to be larger (7.7 cm) yet demonstrated no increased risk of rupture, which was encountered in 33% of patients. Elective operative management was undertaken in 26 patients with a mortality rate of 11%. When repair had to be performed as an emergency procedure mortality increased to 33%. Aneurysm ligation, resection, or endoaneurysmorrhaphy coupled with graft interposition when necessary did not seem to influence patient survival. Eleven patients treated nonoperatively demonstrated enlargement in three, rupture in one, and progressive ureteral obstruction in one patient. Iliac aneurysms demonstrate expansile growth with eruptive and erosive complications and therefore should be managed aggressively under elective circumstances.

Length of stay has minimal impact on the cost of hospital admission

BACKGROUND Hospital cost containment, cost reduction, and alternative care delivery systems continue to preoccupy health care providers, payers, employers, and policy makers throughout the United States. The universal metric for gauging the success of these efforts is hospital length of stay (LOS). Reducing the LOS purportedly yields large cost savings. The purpose of this study is to assess precisely how much hospitals save by shortening LOS. STUDY DESIGN We reviewed the cost-accounting records of all surviving patients (n = 12,365) discharged from our academic medical center during fiscal year 1998 with LOS of 4 days or more. Actual costs were identified through the University of Michigan cost-accounting system. Individual patient costs were broken out on a daily basis and then decomposed further into variable direct, fixed direct, and indirect categories. The population was analyzed by determining the incremental resource cost of the last full day of stay versus the total cost for the entire stay. The data were also stratified by LOS and by surgical costs. An analysis of all trauma patients was then performed on all patients discharged from the hospitals adult level I trauma center (n = 665). Costs were determined on specific days, including admission day, each ICU day, day of discharge from the ICU, and each of the last 2 days before the discharge day. RESULTS The incremental costs incurred by patients on their last full day of hospital stay were

Renal Artery Aneurysms: A 35-year Clinical Experience With 252 Aneurysms in 168 Patients

420 per day on average, or just 2.4% of the

Fetal response to injury in the rabbit

17,734 mean total cost of stay for all 12,365 patients. Mean end-of-stay costs represented only a slightly higher percentage of total costs when LOS was short (e.g., 6.8% for patients with LOS of 4 days). Even when the data were stratified to focus on patients without major operations, the

Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: Interventional versus diagnostic procedures☆

432 average last-day variable direct cost was only 3.4% of the

Twenty-year clinical experience with the Greenfield filter

12,631 average total cost of care. A focus on the trauma center helps to explain this phenomenon. For our trauma center, variable direct costs accounted for 42% of the mean total cost per patient of

Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism.

22,067. The remaining 58% was hospital overhead (fixed and indirect costs). The median variable direct cost on the first day of admission is

Effect of Positive Pressure Ventilation on Surface Tension Properties of Lung Extracts

1,246, and the median variable direct cost on discharge is

Variation in Death Rate After Abdominal Aortic Aneurysmectomy in the United States: Impact of Hospital Volume, Gender, and Age

304. Approximately 40% of the variable costs are incurred during the first 3 days of admission. CONCLUSIONS For most patients, the costs directly attributable to the last day of a hospital stay are an economically insignificant component of total costs. Reducing LOS by as much as 1 full day reduces the total cost of care on average by 3% or less. Going forward, physicians and administrators must deemphasize LOS and focus instead on process changes that better use capacity and alter care delivery during the early stages of admission, when resource consumption is most intense.