Introduction: Peripheral artery disease (PAD) is common and imposes a high risk of major systemic and limb ischemic events and consequently, high healthcare cost. The primary objective of our study is to compare the effect of diabetes mellitus (DM) on hospital cost and length of stay (LOS) of patients receiving endovascular stenting for PAD from a large national database.
Methods: Using the Nationwide Inpatient Sample (NIS) we identified the adult patients hospitalized with PAD who underwent endovascular stenting from 2012-2014. We adjusted our results for potential confounders including mortality, age, gender, race, elective admission, hospital location, hospital teaching status and the Charlson Comorbidity Index.
Results: We identified 26,294 patients (weighted n=131,470) admitted for PAD who underwent endovascular stenting from 2012 to 2014. We divided them into two groups (DM and Non-DM, Table 1). The overall median LOS was 6.5 days (95% confidence interval (CI), 6.3-6.6). The diabetic group tend to have longer LOS (7.5 days vs 5.6 days, p<0.01). Furthermore, hospital cost for diabetic patients was significantly higher when compared to non-diabetic group ($29,940 vs $28,080; p<0.01). Although the mortality of the diabetic patients is not higher than that of the non-diabetic patients, a higher incidence of amputation and evacuation, however, was observed. When the above two factors were adjusted in our model, the hospital cost for diabetic patients was partially correlated with higher incidence of complications such as amputation or evacuation, both are positively correlated with higher total hospitalization cost.
Conclusions: Endovascular stenting for PAD in the diabetic patients is associated with a longer LOS and higher hospitalization costs when compared to non-DM patients which can be partially attributed to high vascular complication rates in diabetic patients.