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Practice pattern variability for myocardial revascularization: impact on resource use across 24 centers.
Joseph S Savino1, Catherine Ley, Denis Boisvert
1University of Pennsylvania Medical Center, Philadelphia, PA 19104-4283, USA. joseph.savino@uphs.upenn.edu
Journal of Cardiothoracic and Vascular Anesthesia
|April 17, 2002
Summary
Hospital length of stay after coronary artery bypass graft surgery varies significantly by institution, not just patient factors. Practice style influences are a key driver of this variability, offering opportunities for cost reduction.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Healthcare Management
Background:
- Hospital length of stay (LOS) is a critical factor in healthcare costs and resource utilization.
- Predicting and managing LOS after major surgical procedures like coronary artery bypass graft (CABG) surgery is essential for efficient healthcare delivery.
- Unexplained variability in LOS suggests potential inefficiencies and opportunities for improvement.
Purpose of the Study:
- To identify predictors of hospital length of stay (LOS) following elective, uncomplicated coronary artery bypass graft (CABG) surgery.
- To investigate the influence of institutional factors on LOS, independent of patient characteristics and complications.
Main Methods:
- Retrospective analysis of the EPI-1 database (1991-1993) including 2,417 patients undergoing elective CABG surgery.
- Multicenter study across 24 academic, private, federal, and health maintenance institutions.
- Multivariate analysis to identify demographic, historical, and practice pattern predictors of LOS in complication-free patients.
Main Results:
- The predominant factor associated with complication-free LOS was the institution (site) itself, explaining 32% of unexplained variability.
- Key predictors of increased LOS included advanced age (>75 years), emergency department admission, lack of insurance, advanced heart failure class, history of arrhythmia, blood transfusions, and delayed extubation.
- Half of the 24 centers reported a mean LOS routinely greater than 7.1 days, with a range from 5.4 to 9.0 days.
Conclusions:
- Institutional differences, termed 'site per se,' significantly influence LOS after uncomplicated CABG surgery, even after accounting for patient severity and practice variations.
- Variability in LOS is likely driven by practice style, representing a significant opportunity to reduce waste in CABG procedures.
- Standardizing care and addressing practice style variations could lead to more efficient and cost-effective delivery of CABG surgery.