RUPTURED ABDOMINAL AORTIC-ANEURYSM REPAIR - THE FINANCIAL ANALYSIS

BACKGROUND: Denial of ruptured abdominal aortic aneurysm (RAAA) repair has been advocated based upon historically poor surgical outcome and a perceived lack of cost effectiveness. Although the repair intuitivel y seems expensive, the actual cost of care, adequacy of reimbursement, and cost per additional life-year gained for RAAA repair are poorly d efined. PATIENTS AND METHODS: Retrospective clinical and financial cha rt review of 119 consecutive patients undergoing operation for RAAA fr om 1986 to 1993. RESULTS: Overall in-hospital mortality was 45%. Mean institutional charge per patient in 1993 dollars was $40,763 (range $4 ,473 to $284,374), with an actual mean cost for service of $22,420 and an average reimbursement of $21,360, resulting in a loss of $1,060 pe r patient. Losses were higher in Medicare patients. Survivors (n = 65) had an average length of stay of 20 days, cost $41,045 each, and incu rred an institutional loss of $298,405. Mean cost per additional (adju sted) life-year was $3,953, One-, 3-, and 5-year survival rates follow ing hospital discharge were 97%, 85%, and 77%, respectively. CONCLUSIO NS: Emergency repair of RAAA is relatively inexpensive when compared t o other commonly used health maintenance protocols and effectively res tores survivors to their former health. Since no clinical or physiolog ic parameter can predict poor outcome, operative intervention should n ot be denied.