Quantifying the risk-adjusted hospital costs of postoperative complications after lower extremity bypass in patients with claudication

J Vasc Surg. 2021 Apr;73(4):1361-1367.e1. doi: 10.1016/j.jvs.2020.08.130. Epub 2020 Sep 12.


Objective: Increasing evidence has shown that the risks associated with surgical revascularization for intermittent claudication outweigh the benefits. The aim of our study was to quantify the cost of care associated with perioperative complications after elective lower extremity bypass (LEB) in patients presenting with intermittent claudication.

Methods: All patients undergoing first-time LEB for claudication in the Healthcare Database (2009-2015) were included. The primary outcome was in-hospital postoperative complications, including major adverse limb events (MALE), major adverse cardiac events (MACE), acute kidney injury, and wound complications. The overall crude hospital costs are reported, and a generalized linear model with log link and inverse Gaussian distribution was used to calculate the predicted hospital costs for specific complications.

Results: Overall, 7154 patients had undergone elective LEB for claudication during the study period. The median age was 66 years (interquartile range, 59-73 years), 67.5% were male, and 75.3% were white. Two thirds of patients (61.2%) had Medicare insurance, followed by private insurance (26.9%), Medicaid (7.7%), and other insurance (4.2%). In-hospital complications occurred in 8.5% of patients, including acute kidney injury in 3.0%, MALE in 2.8%, wound complications in 2.3%, and MACE in 1.0%. The overall median crude hospital cost was $11,783 (interquartile range, $8911-$15,767) per patient. The incremental increase in cost associated with a postoperative complication was significant, ranging from $6183 (95% confidence interval, $4604-$7762) for MALE to $10,485 (95% confidence interval, $6529-$14,441) for MACE after risk adjustment.

Conclusions: Postoperative complications after elective LEB for claudication are not uncommon and increase the in-hospital costs by 46% to 78% depending on the complication. Surgical revascularization for claudication should be used sparingly in carefully selected patients.

Keywords: Intermittent claudication; Lower extremity bypass; Postoperative complications; Premier Healthcare Database; Structured exercise therapy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cost-Benefit Analysis
  • Databases, Factual
  • Elective Surgical Procedures / adverse effects
  • Elective Surgical Procedures / economics
  • Female
  • Hospital Costs*
  • Humans
  • Intermittent Claudication / diagnosis
  • Intermittent Claudication / economics*
  • Intermittent Claudication / surgery*
  • Lower Extremity / blood supply*
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / economics*
  • Peripheral Arterial Disease / surgery*
  • Postoperative Complications / economics*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Grafting / adverse effects*
  • Vascular Grafting / economics*