Introduction: There is paucity of data in the literature about the impact of co-morbidities on the length of hospital stay and the healthcare cost in patients with cerebral aneurysm. We sought to analyze the factors responsible for increased cost and length of hospital stay.
Methods: The NIS database was studied for the patients admitted for ruptured and unruptured aneurysm from the year 2005-2009. Patients were grouped in various categories depending on the type of interventions during their single hospital stay(table 1). Patients were also grouped according to their co-morbidity status(table2).Every patients cost incurred was converted into high and low cost using “quartile” analysis(Table3) .This dataset was analyzed using binary logistic regression models(table4) to assess the relationship of different treatment protocols, age, presence of sub arachnoid hemorrhage and co-morbidities with hospital cost. The difference in length of stay between patients with high and was compared using t test.
Results: A total of 62,839 inpatient admissions for were analyzed from the year 2005-2009. Patients who did not undergo their principal procedure of either clipping or coiling were excluded from analysis. The mean expenditure on patients with low co-morbidity was $126,631 and on patients with high comorbidity was $199,528 and the difference was significant p<0.0001. The mean length of stay of patients with higher co-morbidities was 15.42 days as against 9.25 days and was significant p<0.001(Table4). Binary logistic regression analysis was done(table5). High comorbidity status had a significant independent association with higher cost (p<0.001 and odds ratio of 2.3). Presence of SAH was also significantly and independently associated with higher cost. (p<0.0001, OR 14.7)
Conclusions: Ruptured aneurysm and high co-morbidity status of patients are significant independent predictors of increased length of stay and hospital cost. Medicare and insurance companies should consider these factors while reimbursing the cost to the hospitals.
Patient Care: Since this study is a United States population based study, the
impact of the results may be of significant public health importance.Distribution of reimbursement by medicare / insurance companies will improve patient services and facilities.
Learning Objectives: By the conclusion of the session participants should be able to understand the impact of Comorbidities and ruptured aneurysms on the length of hospital stay and escalate the cost.These factors are very important from medical reimbursement point and should be seriously looked at by medicare