Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 5, November 2013, Pages 1621-1627
The Annals of Thoracic Surgery

Original article
Adult cardiac
A Contemporary Cost Analysis of Postoperative Morbidity After Coronary Artery Bypass Grafting With and Without Concomitant Aortic Valve Replacement to Improve Patient Quality and Cost-Effective Care

Presented at the Poster Session of the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.05.050Get rights and content

Background

The financial burden of postoperative morbidity after cardiac operations remains ill defined. This study evaluated the costs associated with the performance of coronary artery bypass grafting (CABG) with and without aortic valve replacement (AVR) and determined the incremental costs associated with major postoperative complications.

Methods

A total of 65,534 regional patients undergoing CABG (n = 55,167) ± AVR (n = 10,367) were evaluated from 2001 to 2011. Patient-related, hospital-related, and procedure-related cost data were analyzed by use of Medicare-based cost reports. Hierarchical multivariable regression modeling was used to estimate risk-adjusted incremental cost differences in postoperative complications.

Results

The mean age was 64 years, and women accounted for 31% of patients. CABG + AVR patients had higher rates of overall complication (40% vs 35%, p < 0.001) and operative mortality (5% vs 3%, p < 0.001) than did CABG patients. CABG + AVR patients also accrued increased median postoperative lengths of stay (7 vs 5 days, p < 0.001) and total costs ($26,527 vs $24,475, p < 0.001). After mortality risk adjustment, significant positive relationships existed between total costs and major postoperative complications. Interestingly, the highest incremental costs among CABG patients included newly instituted hemodialysis ($71,833), deep sternal wound infection ($56,003), and pneumonia ($50,025). Among CABG + AVR patients, these complications along with perioperative myocardial infarction ($68,917) dominated costs.

Conclusions

Postoperative complications after CABG ± AVR are associated with significantly increased incremental costs. The most costly complications include newly instituted hemodialysis, infectious complications, and perioperative myocardial infarction. Identification of the most common and the most costly complications provides opportunities to target improvement in patient quality and the delivery of cost-effective care.

Section snippets

Material and Methods

This investigation was exempt from institutional review board review at each participating center because of its deidentified nature as a quality database and because of the absence of Health Insurance Portability and Accountability Act patient identifiers.

Patient Characteristics, Operative Features, and Outcomes for CABG ± AVR

Table 1 reports patient characteristics and operative features for all patients undergoing both CABG alone and CABG + AVR. Patients undergoing combined CABG + AVR were on average older, were more commonly female, and presented with increased operative risk for mortality as determined by the presence of baseline comorbid disease and median STS PROM scores in comparison with patients undergoing CABG alone. Cardiopulmonary bypass support was used in 92% of CABG alone operations. Prior CABG and

Comment

The present study reports outcomes, hospital resource utilization, and costs among a multiinstitutional, statewide cohort of patients undergoing CABG with or without concomitant AVR. The reported data represent a 10-year collaborative experience of the VCSQI. The principal findings of this study relate to the impact of postoperative complications on hospital resource utilization and the risk-adjusted incremental costs of hospitalization. Consequently, the results of this study serve to quantify

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