The economic impact of peripheral arterial disease on lower extremity intervention in patients with and without diabetes mellitus. — ASN Events
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The economic impact of peripheral arterial disease on lower extremity intervention in patients with and without diabetes mellitus. (#352)

Matthew Malone 1 , Jessica White 1 , Anna Novak 2 , R Sinclair 2 , Wei Xuan 3 , John Crozier 4 , Hugh Dickson 5
  1. High Risk Foot Service, Liverpool Hospital, Liverpool, NSW, Australia
  2. Finance, Liverpool Hospital, Liverpool, NSW, Australia
  3. Statistics, Inghams Institute for Applied Medical Research, Sydney, NSW, Australia
  4. Vascular Surgery, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia
  5. Ambulatory Care, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia

Objective To determine the economic impact of co-morbidities such as diabetes (DM) and their effect on length of stay (LOS) in patients with peripheral arterial disease (PAD) admitted to a vascular surgery unit for lower limb surgical intervention.

Research Design and Methods A retrospective study was conducted between 1 January 2011 and 7 July 2012 at a tertiary referral hospital in metropolitan Sydney. Demographic, laboratory, and operative report data were obtained from the Australasian Vascular Audit Database. Patients with confirmed PAD with or without DM requiring hospital admission for lower limb surgical intervention were included.

Results A total of 568 admissions (492 patients) were identified, 292 admissions with a diagnosis of PAD and 276 admissions with PAD in conjunction with DM. The mean LOS for patients with PAD was 9.6 days (±13.7) compared to 15.3 days (±18.2) for PADDM (p < 0.0001, 95% CI 2.7 to 8). LOS and economic burden were greatest in patients with PADDM undergoing major amputation (36.6 days ±13.7, $71,620, p < 0.001). Patients with PADDM were 3 times more likely to have an amputation (Relative risk [RR] 2.9, 95% CI 1.9 to 4.3, p < 0.0001). Over 18 months, the economic burden of in-patient costs and surgical procedures relating to PAD (with and without diabetes) amounted to $13,575,989

Conclusion The economic impact of diabetes as a co-morbid condition in patients with PAD is significant. Factors that may predict increased LOS in patients with PAD are bypass surgery, amputation and diabetes mellitus. 

Author Contributions: MM undertook data collection and writing of the main body article, JW and AN undertook literature review and data sorting, RA undertook economic analysis, WX undertook the statistical analysis, JC undertook literature review for discussion section, analysed data and wrote sections of the paper. HD was responsible for the final editorial input for the paper. 

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