Preoperative risk factors for in-hospital mortality and total hospital charges in abdominal aortic surgery patients

Introduction: Preoperative risk stratification provides important information to patients, health care providers, and payers. While considerable attention has been devoted to identifying risk factors for penoperative cardiac events, few studies have evaluated preoperanve risk factors for in-hospital mortality and total hospital charges. We sought to evaluate preoperaove nsk factors for m-hospital mortality and total hospital charges in patients having abdominal aortic surgery in Maryland between 1994-19%. Methods: We obtained discharge abstracts from the Maryland Health Services Cost Review Commission for all patients who had a primary procedure code for abdominal aortic surgery from 1/94-12/96 (N=2987y Our primary outcomes were in-hospital mortality, total hospital charges, hospital length-of-stay, and ICU days. We performed multiple logistic regression adjusting for demographic characteristics (age, sex, race), severity of illness (ruptured aneurysm, urgent admission, emergent admission), co-morbid jiyaat (each >tiyin the Romane-Charbon index), hospital volume and surgical experience (cases per year). All results are adjusted for clustering within hospitals. Rendis: Independent predictors of in-hospital mortality were age 60-69(OR3 1), age 70-85 (OR 7.2), age > 85 (OR 9.3). ruptured aneurysm (OR 5.3), urgent operation (2.3), emergent operation (3.0), mud liver disease (OR 4.6), and chronic renal disease (6.9). Independent predictors of increased total hospital charges were age 60-69 ( 12% increase), age 70-85 (20% increase), age > 85 (31% increase), non-white race (12% increase), ruptured aneurysm (30% increase), urgent operation (21% increase), emergent operation (28% increase), COPD (10% increase), chronic renal failure (104% increase), and malignancy (14% increase). Preoperative hospital admission was not associated with in-hospital mortality but was associated with a 30% increase in total hospital charges. Conclusions: This study demonstrates that chronic renal failure and mild liver disease are important preoperan've risk factors for in-hospital mortality and increased total hospital charges after abdominal aortic surgery. Chronic renal failure was a stronger predictor of a>-hoapital mortality than ruptured aneurysm. to contrast, previous myocardial infarction and diabetes were not associated wim nvhaapital mortality or total hospital charges. Preoperanve hospital admission did not reduce in-nospital mortality, but is associated with increased total hospital charges.