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Evaluation of surgical procedures. Changing patterns of patient selection and costs in heart transplantation
K Reemtsma1, G Berland, J Merrill
1Department of Surgery, Columbia University College of Physicians and Surgeons, Office of Case Mix Studies of the Presbyterian Hospital, New York, NY.
Insights
Heart transplant costs are rising due to sicker patients and longer hospital stays. Survival rates are similar for intensive care unit and non-intensive care unit patients, but long-term disability persists.
Area of Science:
- Cardiology
- Health Economics
- Transplantation Surgery
Background:
- Increasing costs of heart transplantation observed over four years.
- Shift in recipient population towards more severely ill patients, doubling intensive care unit admissions.
- Length of stay in special care and regular nursing units is a major cost driver.
Purpose of the Study:
- To analyze the components of cost increase in heart transplantation.
- To evaluate the impact of pre-transplant intensive care unit status on survival outcomes.
- To assess long-term rehabilitation and disability status post-heart transplantation.
Main Methods:
- Retrospective analysis of heart transplant costs and patient demographics.
- Comparison of survival rates at 1 month and 1 year between intensive care unit and non-intensive care unit recipients.
- Assessment of patient rehabilitation and disability status at 1 year post-transplantation.
Main Results:
- No significant difference in 1-month or 1-year survival between intensive care unit and non-intensive care unit recipients.
- Approximately 80% of patients achieve rehabilitation (work/school) at 1 year.
- Only 20% of patients are off disability rolls, mainly due to insurance and ongoing care costs.
Conclusions:
- Comprehensive evaluation of heart transplantation requires balancing long-term costs with outcomes.
- Patient rehabilitation is high, but financial barriers hinder return to full societal participation.
- Addressing insurance and continuing care costs is crucial for improving long-term patient well-being.
Abstract:
During the past 4 years we have observed a marked increase in costs of heart transplantation in our center. This trend coincides with a shift in our recipient population toward the more severely ill patients. The percentage of patients bound for the intensive care unit has doubled. In analyzing the components of cost, we find that the length of stay, both in special care and regular nursing units, accounts for most of the cost increase. In our study of outcomes we find no significant difference in survival, at 1 month and 1 year, between recipients operated on from the intensive care unit and those not in intensive care. We find that at 1 year after transplantation, approximately 80% of patients are rehabilitated, which we define as the ability to work or to go to school. Only 20% of patients are off disability rolls, however, primarily because of problems related to insurance and the cost of continuing care, including drugs. We conclude that the comprehensive evaluation of surgical procedures requires an approach that balances costs with results on a continuing and long-term basis.
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