Analysis of Midterm Readmissions and Related Costs after Open and Endovascular Procedures for Aorto-Iliac Occlusive Disease

Abstract

Background. Readmissions rates and costs were analysed over follow-up for patients who underwent open or endovascular procedures for aorto-iliac occlusive disease (AIOD). Methods. Patients who underwent aorto-bifemoral bypass (ABF) or covered kissing stent (CKS) for AIOD from May 2008 to February 2018 were compared in terms of readmission rates, related costs expressed in EUR, freedom from generic readmission (FFGR), and freedom from readmission for surgical reasons (FFRS). Results. ABF had a readmission rate of 16% and CKS of 18% (p = 0.999). The most common cause of readmission was prosthesis limb or stent occlusion. Time to readmission was longer for ABF (35 months [21-82] vs. 13.5 months [1-68.7] in the CKS group, p = 0.334). CKS group had higher cumulative re-hospitalisation, ICU stay, and reintervention costs (11569 ± 2216 SEM, 2405 ± 1125, 5264 ± 1230, respectively) and a trend for more readmissions in the first 36 months, without reaching significance. Conclusion. This study reports on a period of time exceeding ninety days. Even if not reaching significance, the CKS group presented a higher trend in readmissions till 36 months and a higher trend in readmission costs, while time-to-readmission was longer in the ABF group.

Keywords: aorto-iliac occlusive disease; cost-analysis; in-hospital readmissions.

Figure 1

Schematic details of reintervention types on both groups. ABF: aorto-bifemoral bypass; CKS: covered kissing stent.

Figure 2

Kaplan–Meier estimates on freedom from generic readmission (FFGR) and freedom from readmission for surgical reasons (FFRS) in both groups, based on a time-to-event analysis. The log-rank test did not show any differences for both analyses, although the CKS group did have a higher rate of readmissions both generic and for surgical reasons in the first 36 months. Standard error < 10%. ABF: aorto-bifemoral bypass; CKS: covered kissing stent.