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Resource utilization related to atrial fibrillation after coronary artery bypass grafting
Marilyn Hravnak1, Leslie A Hoffman, Melissa I Saul
1Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, PA, USA.
Insights
New-onset atrial fibrillation after coronary artery bypass grafting significantly increases hospital resource use and costs. Patients with this condition incurred higher charges for intensive care, medications, and respiratory support, underscoring its substantial economic impact.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Health Economics
Background:
- Previous studies on resource utilization in post-coronary artery bypass grafting (CABG) patients with new-onset atrial fibrillation (AF) focused narrowly on length of stay and bed charges.
- A comprehensive analysis of broader resource utilization is needed to understand the full economic impact of AF following CABG.
Purpose of the Study:
- To conduct a comparative analysis of resource utilization between patients who developed new-onset atrial fibrillation and those who did not, following isolated coronary artery bypass grafting.
- To quantify the differences in hospital costs across various cost centers for these two patient groups.
Main Methods:
- A retrospective review of clinical and administrative electronic databases was performed for 720 patients undergoing isolated CABG with cardiopulmonary bypass.
- Data were collected over 25 months at a single medical center.
- Resource utilization in multiple hospital cost centers was compared between patients with and without new-onset AF.
Main Results:
- The prevalence of new-onset atrial fibrillation was 33.1% among the studied cohort.
- Patients with AF experienced significantly longer hospital stays, increased mechanical ventilation and oxygen therapy days, and higher intensive care unit readmission rates compared to those without AF.
- Subjects with AF incurred higher total postoperative charges, with the largest cost differences observed in bed, laboratory, pharmacy, and respiratory care charges.
Conclusions:
- The economic burden associated with new-onset atrial fibrillation following coronary artery bypass grafting is significantly underestimated by previous assessments.
- Implementing strategies to mitigate AF development or manage it efficiently post-CABG could lead to substantial cost savings.
Background:
Studies of resource utilization by patients with new-onset atrialfibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges.
Objective:
To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrialfibrillation after isolated coronary artery bypass grafting.
Methods:
Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrialfibrillation.
Results:
The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrialfibrillation, subjects with atrialfibrillation had a longer stay (5.8 +/- 2.4 vs. 4.4+/-1.2 days, P<.001), more days receiving mechanical ventilation (P =.002) and oxygen therapy (P<.001), and higher rates of readmission to the intensive care unit (4.6% vs. 0.2%, P<.001). Subjects with atrial fibrillation also had more laboratory tests (P<.001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrialfibrillation had higher total postoperative charges ($57261 +/- $17101 vs. $50905 +/- $10062, P = .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582).
Conclusion:
The economic impact of atrialfibrillation after coronary artery bypass grafting has been underestimated.