Contribution of 30-day readmissions to the increasing costs of care for the diabetic foot

Caitlin Hicks, Joseph K. Canner, Hikmet Karagozlu, Nestoras Nicolas Mathioudakis, Ronald L. Sherman, James Hamilton Black, Christopher Joseph Abularrage

Research output: Contribution to journalArticle

Abstract

Objective: The inpatient cost of care for diabetic foot ulcers (DFUs) has been estimated to be $1.4 billion annually in the United States. We have previously demonstrated that the risk of 30-day unplanned readmission for patients with DFU is nearly 22%. Our aim was to quantify the cost of readmissions for patients admitted with DFU. Methods: All patients presenting to our multidisciplinary diabetic limb preservation service from June 2012 to June 2016 were enrolled in a prospective database. Inpatient costs and net margins were calculated overall and for index admissions vs 30-day unplanned readmissions. Results: A total of 249 admissions for 150 patients were included. Of these, 206 admissions were index admissions and 43 were 30-day readmissions. The most common reason for readmission was the foot wound (49%), followed by a bypass wound (14%), renal complications (9%), and other systemic complications. Surgical interventions during readmission were common (47%) and included both podiatric (37%) and vascular (23%). The wound healing outcomes were favorable, with 78% of all wounds achieving healing by 1 year. Limb salvage was 91% overall. The median hospital cost per admission was $20,111 (interquartile range, $12,589-$33,254) and did not differ between the index and readmissions ($22,165 vs $19,408; P =.46). However, the hospital net margins were lower after readmission ($3908 vs $1975; P =.02). The overall cost of care for patients requiring readmission was significantly greater than that for patients not readmitted ($79,315 vs $28,977; P <.001). During the study period, DFU care at our institution cost $7.9 million, of which $1.2 million (16%) was attributable to readmission costs. Conclusions: Readmissions for patients with DFU are common and associated with a substantial cost burden. The cost of readmission for patients with DFU was as high as the cost of the index admission but with lower hospital net margins. When extrapolated to national data, the 15% readmission cost burden we have reported would be equivalent to $210 million hospital costs annually. Focused efforts at preventing readmissions in this high-risk patient population are essential to reducing the overall costs of care associated with DFUs.

Original languageEnglish (US)
JournalJournal of vascular surgery
DOIs
StatePublished - Jan 1 2019

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Diabetic Foot
Costs and Cost Analysis
Patient Readmission
Hospital Costs
Wound Healing
Inpatients
Limb Salvage
Patient Admission
Wounds and Injuries
Blood Vessels
Foot
Extremities
Databases

Keywords

  • Cost
  • Diabetic foot ulcer
  • Multidisciplinary care
  • Net margins
  • Readmission

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{baa45d94d8194ee0b5a43238a9d9439f,
title = "Contribution of 30-day readmissions to the increasing costs of care for the diabetic foot",
abstract = "Objective: The inpatient cost of care for diabetic foot ulcers (DFUs) has been estimated to be $1.4 billion annually in the United States. We have previously demonstrated that the risk of 30-day unplanned readmission for patients with DFU is nearly 22{\%}. Our aim was to quantify the cost of readmissions for patients admitted with DFU. Methods: All patients presenting to our multidisciplinary diabetic limb preservation service from June 2012 to June 2016 were enrolled in a prospective database. Inpatient costs and net margins were calculated overall and for index admissions vs 30-day unplanned readmissions. Results: A total of 249 admissions for 150 patients were included. Of these, 206 admissions were index admissions and 43 were 30-day readmissions. The most common reason for readmission was the foot wound (49{\%}), followed by a bypass wound (14{\%}), renal complications (9{\%}), and other systemic complications. Surgical interventions during readmission were common (47{\%}) and included both podiatric (37{\%}) and vascular (23{\%}). The wound healing outcomes were favorable, with 78{\%} of all wounds achieving healing by 1 year. Limb salvage was 91{\%} overall. The median hospital cost per admission was $20,111 (interquartile range, $12,589-$33,254) and did not differ between the index and readmissions ($22,165 vs $19,408; P =.46). However, the hospital net margins were lower after readmission ($3908 vs $1975; P =.02). The overall cost of care for patients requiring readmission was significantly greater than that for patients not readmitted ($79,315 vs $28,977; P <.001). During the study period, DFU care at our institution cost $7.9 million, of which $1.2 million (16{\%}) was attributable to readmission costs. Conclusions: Readmissions for patients with DFU are common and associated with a substantial cost burden. The cost of readmission for patients with DFU was as high as the cost of the index admission but with lower hospital net margins. When extrapolated to national data, the 15{\%} readmission cost burden we have reported would be equivalent to $210 million hospital costs annually. Focused efforts at preventing readmissions in this high-risk patient population are essential to reducing the overall costs of care associated with DFUs.",
keywords = "Cost, Diabetic foot ulcer, Multidisciplinary care, Net margins, Readmission",
author = "Caitlin Hicks and Canner, {Joseph K.} and Hikmet Karagozlu and Mathioudakis, {Nestoras Nicolas} and Sherman, {Ronald L.} and Black, {James Hamilton} and Abularrage, {Christopher Joseph}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2018.12.028",
language = "English (US)",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Contribution of 30-day readmissions to the increasing costs of care for the diabetic foot

AU - Hicks, Caitlin

AU - Canner, Joseph K.

AU - Karagozlu, Hikmet

AU - Mathioudakis, Nestoras Nicolas

AU - Sherman, Ronald L.

AU - Black, James Hamilton

AU - Abularrage, Christopher Joseph

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The inpatient cost of care for diabetic foot ulcers (DFUs) has been estimated to be $1.4 billion annually in the United States. We have previously demonstrated that the risk of 30-day unplanned readmission for patients with DFU is nearly 22%. Our aim was to quantify the cost of readmissions for patients admitted with DFU. Methods: All patients presenting to our multidisciplinary diabetic limb preservation service from June 2012 to June 2016 were enrolled in a prospective database. Inpatient costs and net margins were calculated overall and for index admissions vs 30-day unplanned readmissions. Results: A total of 249 admissions for 150 patients were included. Of these, 206 admissions were index admissions and 43 were 30-day readmissions. The most common reason for readmission was the foot wound (49%), followed by a bypass wound (14%), renal complications (9%), and other systemic complications. Surgical interventions during readmission were common (47%) and included both podiatric (37%) and vascular (23%). The wound healing outcomes were favorable, with 78% of all wounds achieving healing by 1 year. Limb salvage was 91% overall. The median hospital cost per admission was $20,111 (interquartile range, $12,589-$33,254) and did not differ between the index and readmissions ($22,165 vs $19,408; P =.46). However, the hospital net margins were lower after readmission ($3908 vs $1975; P =.02). The overall cost of care for patients requiring readmission was significantly greater than that for patients not readmitted ($79,315 vs $28,977; P <.001). During the study period, DFU care at our institution cost $7.9 million, of which $1.2 million (16%) was attributable to readmission costs. Conclusions: Readmissions for patients with DFU are common and associated with a substantial cost burden. The cost of readmission for patients with DFU was as high as the cost of the index admission but with lower hospital net margins. When extrapolated to national data, the 15% readmission cost burden we have reported would be equivalent to $210 million hospital costs annually. Focused efforts at preventing readmissions in this high-risk patient population are essential to reducing the overall costs of care associated with DFUs.

AB - Objective: The inpatient cost of care for diabetic foot ulcers (DFUs) has been estimated to be $1.4 billion annually in the United States. We have previously demonstrated that the risk of 30-day unplanned readmission for patients with DFU is nearly 22%. Our aim was to quantify the cost of readmissions for patients admitted with DFU. Methods: All patients presenting to our multidisciplinary diabetic limb preservation service from June 2012 to June 2016 were enrolled in a prospective database. Inpatient costs and net margins were calculated overall and for index admissions vs 30-day unplanned readmissions. Results: A total of 249 admissions for 150 patients were included. Of these, 206 admissions were index admissions and 43 were 30-day readmissions. The most common reason for readmission was the foot wound (49%), followed by a bypass wound (14%), renal complications (9%), and other systemic complications. Surgical interventions during readmission were common (47%) and included both podiatric (37%) and vascular (23%). The wound healing outcomes were favorable, with 78% of all wounds achieving healing by 1 year. Limb salvage was 91% overall. The median hospital cost per admission was $20,111 (interquartile range, $12,589-$33,254) and did not differ between the index and readmissions ($22,165 vs $19,408; P =.46). However, the hospital net margins were lower after readmission ($3908 vs $1975; P =.02). The overall cost of care for patients requiring readmission was significantly greater than that for patients not readmitted ($79,315 vs $28,977; P <.001). During the study period, DFU care at our institution cost $7.9 million, of which $1.2 million (16%) was attributable to readmission costs. Conclusions: Readmissions for patients with DFU are common and associated with a substantial cost burden. The cost of readmission for patients with DFU was as high as the cost of the index admission but with lower hospital net margins. When extrapolated to national data, the 15% readmission cost burden we have reported would be equivalent to $210 million hospital costs annually. Focused efforts at preventing readmissions in this high-risk patient population are essential to reducing the overall costs of care associated with DFUs.

KW - Cost

KW - Diabetic foot ulcer

KW - Multidisciplinary care

KW - Net margins

KW - Readmission

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DO - 10.1016/j.jvs.2018.12.028

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JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

ER -