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Economic and clinical impact of routine weekend catheterization services
Kristen Hall Long1, James P Moriarty, Jeanine E Ransom
1Long Health Economics Consulting LLC, 855 Village Center Dr #111, St. Paul, MN 55127.
Insights
Implementing weekend cardiac catheterization services for nonemergent inpatients is safe and effective, significantly reducing hospital length of stay without increasing costs.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Nonemergent cardiac catheterization is typically performed on weekdays.
- The impact of extending these services to weekends on patient outcomes and resource utilization is not well-established.
Purpose of the Study:
- To evaluate the clinical safety and effectiveness of weekend cardiac catheterization services for nonemergent inpatients.
- To assess the impact of Saturday catheterization availability on hospital length of stay and costs.
Main Methods:
- Retrospective cohort study comparing patients undergoing cardiac catheterization before and after the implementation of Saturday catheterization services.
- Analysis of administrative and registry data including demographics, comorbidities, percutaneous coronary intervention details, adverse events, length of stay, and inpatient expenditures.
- Generalized linear modeling and logistic regression were used to analyze outcomes.
Main Results:
- PCI use increased significantly after Saturday catheterization availability (42% vs 26%).
- Procedural success rates were high in both groups (95% pre-CSA, 94% post-CSA).
- Hospital length of stay was reduced by an average of 1.7 days post-implementation (4.0 vs 5.7 days), while inpatient costs remained similar.
Conclusions:
- Weekend cardiac catheterization services for nonemergent inpatients are clinically safe and effective.
- The availability of Saturday catheterization services can lead to a significant reduction in hospital length of stay.
- Similar inpatient costs suggest a potential shift in case mix, warranting further investigation.
Objectives:
To assess the impact of weekend cardiac catheterization (cath) services for nonemergent inpatients.
Study Design:
Retrospective cohort study of patients undergoing cath before and after Saturday cath service availability (CSA).
Methods:
Cohorts included Friday and Saturday admissions with cath (with or without revascularization) on the subsequent Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and Friday or Saturday admissions undergoing cath the subsequent or same Saturday from January 1, 2009, to December 31, 2010 (post-CSA events). Administrative and registry data provided demographics, comorbidities, percutaneous coronary intervention (PCI) details, adverse events, hospital length of stay (LOS), and inpatient expenditures. We used generalized linear modeling to predict LOS and costs, and logistic regression to estimate the likelihood of adverse events during follow-up.
Results:
We identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243 patients). Cohorts were similar in age (66 years), sex (59% male), and level of comorbidity. PCI use was higher following CSA (42% vs 26%; P <.001), with procedural success accomplished in 95% and 94% of pre- and post-CSA patients, respectively. Adjusted clinical outcomes were similar (odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P = .55; OR for 30-day revascularization, 1.14; P = .68). Models predict an average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001) yet inpatient costs were similar ($24,817 vs $24,753; 95% CI of difference, -$3611 to $3576).
Conclusions:
Weekend CSA for routine inpatients was clinically safe and effective, and reduced hospital LOS. Similar inpatient costs likely reflect a shift in case mix in this nonrandomized study.
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