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Coronary artery bypass graft surgery: do women cost more?
A Bestawros1, Kristian B Filion, Seema Haider
1Montreal General Hospital/McGill University, Montreal, Canada.
Insights
Women undergoing coronary artery bypass graft surgery (CABG) experience longer hospital stays and higher mortality, leading to increased costs. While female sex is a minor cost determinant, rising CABG rates in women present a significant economic challenge.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Health Services Research
Background:
- Coronary artery bypass graft surgery (CABG) outcomes differ between sexes, with women historically facing worse results.
- The economic impact of sex on CABG costs remains under-researched.
Purpose of the Study:
- To investigate the influence of sex on the hospital course and associated costs of CABG.
- To compare the length of stay, mortality rates, and financial expenditures between male and female CABG patients.
Main Methods:
- Analysis of 12,017 patients (24% female) undergoing CABG across nine hospitals in Canada and the US.
- Utilized hospital resource and cost accounting system data to examine hospital course and costs.
- Adjusted for age and comorbid conditions to determine the independent impact of sex.
Main Results:
- Women experienced significantly longer lengths of stay (LOS) and higher in-hospital mortality compared to men.
- Unadjusted total costs were higher for women in both Canadian and US hospitals.
- After adjustments, female sex was linked to a 10% increase in LOS, a 97% increase in mortality, and a 7% increase in overall cost.
Conclusions:
- Women undergoing CABG have modestly increased LOS and mortality, with higher total in-hospital costs.
- While female sex is a minor determinant of CABG cost compared to other clinical factors, the projected increase in female CABG patients suggests a substantial future economic burden.
Background:
Coronary artery bypass graft surgery (CABG) in women has been associated with worse clinical outcomes than CABG in men. However, little is known about the impact of sex on the cost of CABG.
Objective:
To examine the impact of sex on hospital course and the cost of CABG.
Methods:
Hospital course and cost were examined among 2880 female and 9137 male patients from four Canadian and five American hospitals. Data were obtained from a resource and cost accounting system used by each of the nine hospitals.
Results:
Among the 12,017 patients who underwent CABG, 24% (n=2880) were women and 76% (n=9137) were men. Women had a significantly longer length of stay (LOS) than did men (10.3+/-0.2 days and 8.9+/-0.08 days, respectively; P<0.0001) and a significantly higher in-hospital mortality than did men (2.6% and 1.5%, respectively; P<0.0001). The total unadjusted cost was higher for women than for men both in Canada (US$11,200+/-268 and US$10,143+/-139, respectively; P<0.0001) and the United States (US$22,715+/-509 and US$19,906+/-269, respectively; P<0.0001). After adjusting for age and comorbid conditions, female sex was associated with a 10% increase in LOS (P<0.0001), a 97% increase in mortality (P=0.0006) and a 7% increase in overall cost (P<0.0001).
Conclusion:
Compared with men, women undergoing CABG had a modestly increased LOS and a higher mortality. Total in-hospital cost was higher for women in each of the nine hospitals studied. Compared with other clinical variables, female sex is a relatively minor determinant of cost. Nevertheless, because of the expected increase in the number of women undergoing CABG in the future, this increased cost may translate into an important economic burden.
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