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Published on: March 27, 2018
Myocardial infarction following coronary artery bypass graft surgery increases healthcare resource utilization
John C Chen1, Padma Kaul, Jerrold H Levy
1Division of Cardiothoracic Surgery, University of Hawaii School of Medicine, Honolulu, USA.
Insights
Perioperative myocardial infarction after coronary artery bypass graft surgery significantly increases intensive care unit time, hospital stay, and overall healthcare costs. This impacts both hospital and physician service expenses, highlighting increased resource utilization.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Critical Care Medicine
Background:
- Coronary artery bypass graft (CABG) surgery is a major cardiovascular procedure.
- Perioperative myocardial infarction (MI) is a known complication with potential economic consequences.
- Understanding the health economic impact of perioperative MI is crucial for resource allocation and patient management.
Purpose of the Study:
- To assess the health economic impact of perioperative myocardial infarction (MI) in patients undergoing coronary artery bypass graft (CABG) surgery.
- To quantify the increased resource utilization and costs associated with perioperative MI.
Main Methods:
- Retrospective cohort analysis of 2,102 patients undergoing CABG surgery across 147 U.S. hospitals.
- Data sourced from hospital bills and uniform billing forms (January 2002 - February 2003).
- Comparison of resource utilization and costs between patients with and without MI by postoperative day 4, with adjustments for baseline characteristics.
Main Results:
- Perioperative MI occurred in 9.1% of CABG patients.
- MI was associated with a doubling of intensive care unit (ICU) time and a 48% increase in hospital length of stay.
- MI led to a 43% increase in hospital costs, 29% in physician services, and 41% in total index hospitalization costs, with a 38% increase in 6-month cumulative costs.
Conclusions:
- Perioperative myocardial infarction following CABG surgery significantly increases healthcare resource utilization, including ICU time and hospital length of stay.
- These complications translate to substantially higher hospital and physician service costs.
- The findings underscore the significant economic burden of perioperative MI in CABG patients.
Objective:
To assess the health economic impact of perioperative myocardial infarction in a cohort of patients undergoing coronary artery bypass graft surgery.
Design:
Retrospective cohort analysis using data from hospital bills and uniform billing forms.
Setting:
A total of 147 geographically diverse hospitals in the United States.
Patients:
The study population consisted of 2,102 coronary artery bypass graft surgery patients enrolled in the PRIMO-CABG trial at U.S. sites between January 2002 and February 2003.
Interventions:
None.
Measurements And Main Results:
Resource utilization and costs during the index hospitalization and during a 6-month follow-up period were compared between patients who had a myocardial infarction by postoperative day 4 and those who did not. Linear regression was used to examine whether myocardial infarction by day 4 was associated with index hospitalization costs, after adjusting for baseline characteristics. Myocardial infarction occurred in 191 (9.1%) patients undergoing coronary artery bypass graft surgery. Myocardial infarction was associated with a doubling of intensive care unit time (3.5 days among patients with no myocardial infarction and 7.1 days among patients with myocardial infarction, p < .01) and a 48% increase in hospital length of stay. Myocardial infarction by day 4 was associated with a 43% increase in hospital costs, a 29% increase in physician service costs, a 41% increase in total costs during the index hospitalization, and a 38% increase in cumulative 6-month costs. After baseline adjustment, myocardial infarction continued to be associated with higher index hospitalization costs.
Conclusions:
Myocardial infarction following coronary artery bypass graft surgery was associated with a significant increase in intensive care unit time, hospital length of stay, and overall costs, which contributed to greater hospital and physician service costs. Healthcare resource utilization is increased in patients sustaining a myocardial infarction following coronary artery bypass graft surgery.
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