Skip to main content

Advertisement

Log in

The relationship between medical expenses and the severity of peripheral arterial disease in Japan

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The main objective is to examine whether the severity of peripheral arterial disease (PAD) affects the expenses and hospital stay of the patients who undergo bypass surgery below the inguinal ligament for PAD. Eighty consecutive patients who underwent infrainguinal bypass surgery for PAD between January 2012 and December 2014 were included in the study. Patients were divided into groups according to their critical limb ischemia (CLI) symptoms and the Wound, Ischemia, and Foot Infection (WIfI) classification. As endpoints, we assessed the duration of postoperative hospital stay and expenses during hospitalization. CLI was a significant factor for longer hospital stay and increased medical expenses (p = 0.009 and p = 0.001). In the patients with CLI, significant factors for longer hospital stay and increased medical expenses were (1) history of distal bypass (p = 0.33 and p = 0.003, respectively) and stage 4 local lower limb status in WIfI classification (p = 0.0007 and p = 0.053). PAD severity was associated with prolonged postoperative hospital stay and increased medical expenses. The presence or absence of CLI and its severity according to the WIfI classification correlated with medical expenses and hospital stay duration between the milder and severe groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kadota A, Miura K, Ueshima H (2010) Diabetes and cardiovascular disease in NIPPON DATA. Nihon Rinsho 68:847–852

    PubMed  Google Scholar 

  2. Nakano T, Ito H (2007) Epidemiology of diabetes mellitus in old age in Japan. Diabetes Res Clin Pract 77(Suppl 1):S76–S81

    Article  PubMed  Google Scholar 

  3. Turek P, Lietava J, Foltan V, Kosmalova V, Dukat A (2010) Costs related to medical treatment for common cardiovascular risk factors. Bratisl Lek Listy 111:535–540

    PubMed  CAS  Google Scholar 

  4. Chodick G, Heymann AD, Wood F, Kokia E (2005) The direct medical cost of diabetes in Israel. Eur J Health Econ 6:166–171

    Article  PubMed  Google Scholar 

  5. Chodick G, Porath A, Alapi H, Sella T, Flash S, Wood F, Shalev V (2010) The direct medical cost of cardiovascular diseases, hypertension, diabetes, cancer, pregnancy and female infertility in a large HMO in Israel. Health Policy 95:271–276

    Article  PubMed  Google Scholar 

  6. Seuring T, Archangelidi O, Suhrcke M (2015) The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics 33:811–831

    Article  PubMed  PubMed Central  Google Scholar 

  7. Penaloza-Ramos MC, Jowett S, Barton P, Roalfe A, Fletcher K, Taylor CJ, Hobbs FR, McManus RJ, Mant J (2016) Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: economic analysis of the PAST-BP study. Eur J Prev Cardiol 23(15):1590–1598

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fan GQ, Fu KL, Jin CW, Wang XZ, Han L, Wang H, Zhong M, Zhang Y, Zhang W, Wang ZH (2015) A medical costs study of older patients with acute myocardial infarction and metabolic syndrome in hospital. Clin Interv Aging 10:329–337

    PubMed  PubMed Central  Google Scholar 

  9. Mills JL Sr, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G, Society for Vascular Surgery Lower Extremity Guidelines C (2014) The Society for Vascular Surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 59:220–234.e1–2

    Article  PubMed  Google Scholar 

  10. Zhan LX, Branco BC, Armstrong DG, Mills JL Sr (2015) The Society for Vascular Surgery lower extremity threatened limb classification system based on wound, ischemia, and foot infection (WIfI) correlates with risk of major amputation and time to wound healing. J Vasc Surg. https://doi.org/10.1177/2047487316651982

    Article  PubMed  Google Scholar 

  11. Yamamoto K, Kitaoka T, Matsumoto H, Deguchi J, Sato O (2011) Preoperative non-ambulatory status predicts poor outcome after below knee bypass surgery. Ann Vasc Dis 4:204–208

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bernhard VM, Boren CH, Towne JB (1980) Pneumatic tourniquet as a substitute for vascular clamps in distal bypass surgery. Surgery 87:709–713

    PubMed  CAS  Google Scholar 

  13. Sato O, Miyata T, Shindo S, Takayama Y, Tada Y (1999) Nondissection method in distal arterial bypass surgery. Acta Chir Belg 99:147–150

    PubMed  CAS  Google Scholar 

  14. Shindo S, Iyori K, Kobayashi M, Suzuki O, Kamiya K, Tada Y, Takayama Y, Miyata T, Sato O, Takagi A (1998) Nondissection method for tibial bypass surgery using Esmarch’s rubber bandage or an automatic sequential pneumatic tourniquet: long-term results. Cardiovasc Surg 6:27–33

    Article  PubMed  CAS  Google Scholar 

  15. Yamada T, Onishi K, Utsunomiya M, Nakamura M (2013) Our treatment strategy for critical limb ischemia. Int J Vasc Med 2013:437471

    PubMed  PubMed Central  Google Scholar 

  16. Gatti C, Cecchini S, Fabbietti P, Romagnoli F, Ricci S (2017) Endovascular treatment of diabetic peripheral arterial disease in older and oldest old patients: a retrospective study. Aging Clin Exp Res. https://doi.org/10.1007/s40520-017-0760-5

    Article  PubMed  Google Scholar 

  17. Shiba T, Ishii S, Okamura T, Mitsuyoshi R, Pfarr E, Koiwai K (2017) Efficacy and safety of empagliflozin in Japanese patients with type 2 diabetes mellitus: a sub-analysis by body mass index and age of pooled data from three clinical trials. Diabetes Res Clin Pract 131:169–178

    Article  PubMed  CAS  Google Scholar 

  18. Hoshina K, Yamamoto K, Miyata T, Watanabe T (2016) Outcomes of critical limb ischemia in hemodialysis patients after distal bypass surgery—poor limb prognosis with stage 4 wound, ischemia, and foot infection (WIfI). Circ J 80:2382–2387

    Article  PubMed  Google Scholar 

  19. Jansson SA, Andersson F, Borg S, Ericsson A, Jonsson E, Lundback B (2002) Costs of COPD in Sweden according to disease severity. Chest 122:1994–2002

    Article  PubMed  Google Scholar 

  20. Mittmann N, Kuramoto L, Seung SJ, Haddon JM, Bradley-Kennedy C, Fitzgerald JM (2008) The cost of moderate and severe COPD exacerbations to the Canadian healthcare system. Respir Med 102:413–421

    Article  PubMed  CAS  Google Scholar 

  21. Oostenbrink JB, Rutten-van Molken MP (2004) Resource use and risk factors in high-cost exacerbations of COPD. Respir Med 98:883–891

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kota Yamamoto.

Ethics declarations

Conflict of interest

All authors have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 11 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seo, A., Yamamoto, K., Akai, A. et al. The relationship between medical expenses and the severity of peripheral arterial disease in Japan. Heart Vessels 33, 853–858 (2018). https://doi.org/10.1007/s00380-018-1127-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1127-3

Keywords

Navigation