Cost Analysis of Open and Endovascular Interventions for Acute vs Chronic Limb Ischemia

Document Type

Conference Proceeding

Publication Date

6-1-2025

Publication Title

J Vasc Surg

Abstract

Objectives: Acute limb ischemia (ALI) and chronic limb-threatening ischemia (CLTI) represent critical vascular diagnoses requiring resource intensive management through open or endovascular interventions. Although both diagnoses are reimbursed under the same diagnosis-related groups (DRGs), the costs associated with ALI and CLTI management remain poorly understood. This study aims to determine and compare the costs of both open and endovascular treatments for ALI and CLTI, providing insight on the economic challenges of treating these conditions. Methods: A retrospective review of all patients in a quaternary medical center who received treatment for ALI or CLTI between 2016 and 2020 was performed. Patients were identified using procedural codes for open and endovascular interventions. Exclusion criteria included trauma-related ischemia and incomplete cost data. Baseline demographics, treatment characteristics, and direct hospital costs, which include professional charges (physician management and surgery fees) and technical charges (facility fees, equipment costs, and consumables), were collected. Bivariate and multivariate regression analyses were performed to assess cost differences between ALI and CLTI. Results: A total of 494 patients were included in the analysis (ALI: n = 202; CLTI: n = 292). Patients with CLTI were older (74.6 vs 71.3 years; P = .484) and had more comorbidities including chronic kidney disease (26.7% vs 17.6%; P = .005), diabetes mellitus (57.1% vs 41.2%; P < .001), hypertension (82.9% vs 78.9%; P = .003), and hyperlipidemia (74.9% vs 59.3%; P = .003) (Table I). Patients with ALI demonstrated significantly higher costs compared with those with CLTI, driven by increased professional and technical charges. Professional charges, which include physician management and surgery fees, were higher for ALI patients ($25,269 vs $17,055; P < .001). Similarly, technical charges, encompassing facility fees, equipment costs, and consumables, were also higher ($152,880 vs $98,989; P < .001) (Table II). ALI was associated with longer lengths of stay (LOS) (9 days vs 6 days; P < .001), contributing to the higher costs across both treatment modalities. Open ALI procedures cost an average of $39,985 more than open CLTI procedures (P = .004), whereas endovascular ALI procedures cost $28,319 more than their CLTI counterparts (P = .015). Multivariate analysis confirmed that both endovascular (P = .004) and open (P = .008) ALI procedures were significantly more expensive than similar procedures for CLTI. Conclusions: ALI is associated with significantly higher costs than CLTI for both open and endovascular treatments. Higher professional and technical charges for ALI resulted from the need for multiple surgical interventions, prolonged operating room time, increased need for consumables, and extended LOS. The economic burden of ALI management highlights the need for coding and billing adjustments. [Formula presented] [Formula presented]

Volume

81

Issue

6

First Page

e231

Last Page

e232

Find It @ Sladen

Share

COinS