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Clinical research study Abdominal aortic and iliac artery aneurysms| Volume 71, ISSUE 4, P1190-1199.e5, April 01, 2020

Hospital resource use and costs among abdominal aortic aneurysm repair patients admitted to the intensive care unit

  • Shannon M. Fernando
    Correspondence
    Correspondence: Shannon M. Fernando, MD, MSc, Department of Critical Care Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Daniel I. McIsaac
    Affiliations
    Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada

    School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Dalibor Kubelik
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
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  • Bram Rochwerg
    Affiliations
    Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada

    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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  • Kednapa Thavorn
    Affiliations
    School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Kaitlyn Montroy
    Affiliations
    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Maya Halevy
    Affiliations
    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Emma Ullrich
    Affiliations
    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Jonathan Hooper
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Alexandre Tran
    Affiliations
    School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada

    Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
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  • Sudhir Nagpal
    Affiliations
    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
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  • Peter Tanuseputro
    Affiliations
    School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Kwadwo Kyeremanteng
    Affiliations
    Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Institut du Savoir Montfort, Ottawa, Ontario, Canada
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Published:September 05, 2019DOI:https://doi.org/10.1016/j.jvs.2019.07.051

      Abstract

      Background

      Abdominal aortic aneurysm (AAA) repair is associated with significant morbidity and mortality. As a result, many of these patients are monitored postoperatively in the intensive care unit (ICU). However, little is known about resource utilization and costs associated with ICU admission in this population. We sought to evaluate predictors of total costs among patients admitted to the ICU after repair of nonruptured or ruptured AAA.

      Methods

      We retrospectively analyzed prospectively collected data (2011-2016) of ICU patients admitted after AAA repair. The primary outcome was total hospital costs. We used elastic net regression to identify pre-ICU admission predictors of hospitalization costs separately for nonruptured and ruptured AAA patients.

      Results

      We included 552 patients in the analysis. Of these, 440 (79.7%) were admitted after repair of nonruptured AAA, and 112 (20.3%) were admitted after repair of ruptured AAA. The mean age of patients with nonruptured AAA was 74 (standard deviation, 9) years, and the mean age of patients with ruptured AAA was 70 (standard deviation, 8) years. Median total hospital cost (in Canadian dollars) was $21,555 (interquartile range, $17,798-$27,294) for patients with nonruptured AAA and $33,709 (interquartile range, $23,173-$53,913) for patients with ruptured AAA. Among both nonruptured and ruptured AAA patients, increasing age, illness severity, use of endovascular repair, history of chronic obstructive pulmonary disease, and excessive blood loss (≥4000 mL) were associated with increased costs, whereas having an anesthesiologist with vascular subspecialty training was associated with lower costs.

      Conclusions

      Patient-, procedure-, and clinician-specific variables are associated with costs in patients admitted to the ICU after repair of AAA. These factors may be considered future targets in initiatives to improve cost-effectiveness in this population.

      Keywords

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