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Bleeding After Cardiac Surgery Is Associated With an Increase in the Total Cost of the Hospital Stay
Andrew E Newcomb1, Rebecca Dignan2, Patrick McElduff3
1Department of Cardiothoracic Surgery, Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Australia.
Insights
Bleeding events significantly increase cardiac surgery costs by over 75%, adding approximately $33,338 per patient. Identifying presurgery risk factors for bleeding can help mitigate these increased hospital expenses.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Patient Outcomes
Background:
- Cardiac surgery complications can prolong hospital stays and increase costs.
- Bleeding events are a significant complication, defined by transfusion needs or reoperation.
- Presurgery patient characteristics influence both bleeding risk and overall hospital costs.
Purpose of the Study:
- To identify presurgery patient characteristics associated with cardiac surgery costs.
- To quantify the cost impact of bleeding events post-cardiac surgery.
- To identify presurgery risk factors predictive of bleeding events.
Main Methods:
- Prospective cohort study of 1459 patients undergoing cardiac surgery in Australia (2014-2015).
- Utilized data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry.
- Collected cost data through state-level hospital data collection.
Main Results:
- Numerous baseline patient characteristics correlated with total cardiac surgery costs.
- Bleeding events increased cardiac surgery costs by 1.76 times (P < .001).
- Bleeding events led to a median cost increase of AUD $33,338.
Conclusions:
- Bleeding events substantially elevate cardiac surgery costs.
- Identified risk factors for bleeding can inform targeted interventions.
- Early identification of at-risk patients may facilitate preventative strategies at the heart team level.
Background:
Cardiac surgery results in complications for some patients that lead to a longer hospital stay and higher costs. This study identified the presurgery characteristics of patients that were associated with the cost of their hospital stay and estimated how much of that cost could be attributed to a bleeding event, defined as requiring 3 units or more of packed red blood cells or returning to the operating room for bleeding. We also identified the presurgery characteristics that were associated with the bleeding event.
Methods:
This prospective cohort of patients (n = 1459) underwent cardiac surgery at 3 tertiary referral hospitals in Australia during 2014 and 2015. Clinical data included the variables held by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry. Cost data were collected as part of a state-level hospital data collection.
Results:
Many of the baseline patient characteristics were associated with the total cost of cardiac surgery. After adjusting for these characteristics, the cost of cardiac surgery was 1.76 (confidence interval, 1.64-1.90) times higher for patients who had a bleeding event (P < .001), thus resulting in a median increase in costs (in Australian dollars) of $33,338 (confidence interval, $21,943-$38,415). Several baseline characteristics were strongly associated with a bleeding event.
Conclusions:
The impact of a bleeding event on the cost of cardiac surgery is substantial. This study identified a set of risk factors for bleeding that could be used to identify patients for discussion at the heart team level, where measures to minimize the risk of transfusion may be initiated.
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