Related Experiment Video
Updated: Nov 9, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Hospital variability in modifiable factors driving coronary artery bypass charges
Rawn Salenger1, Eric W Etchill2, Clifford E Fonner3
1Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md; Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
Insights
Hospital charges for coronary artery bypass grafting (CABG) vary widely. Modifiable factors like longer preoperative stay and operating room time significantly impact costs, offering opportunities for savings and improved care.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Health Services Research
Background:
- Coronary artery bypass grafting (CABG) procedures exhibit substantial interhospital charge variations.
- The underlying drivers of these significant hospital charge disparities for CABG remain largely unidentified.
- Understanding modifiable factors is crucial for addressing cost variability in CABG.
Purpose of the Study:
- To identify modifiable factors associated with interhospital charge variability for coronary artery bypass grafting (CABG).
- To analyze which independently associated factors exhibit variation between hospitals.
- To inform strategies for cost reduction and quality improvement in CABG.
Main Methods:
- Linked Society of Thoracic Surgeons data with Maryland Health Care Commission charge data for isolated CABG patients (2012-2016).
- Employed multivariable linear regression to identify perioperative factors related to CABG charges.
- Analyzed the interhospital variability of identified cost-associated factors.
Main Results:
- Mean normalized CABG charges varied significantly across Maryland hospitals ($30,000-$57,000).
- Increased charges correlated with longer preoperative length of stay, operating room time, and postoperative morbidity (stroke, renal failure, prolonged ventilation, reoperation, deep sternal wound infection).
- Patient risk profile explained only ~10% of charge variance; postoperative events (except stroke, wound infection) varied significantly between hospitals.
Conclusions:
- Significant charge variability exists for CABG among hospitals within the same state.
- Targeting variations in preoperative length of stay, operating room time, postoperative renal failure, prolonged ventilation, and reoperation can yield cost savings.
- Optimizing these modifiable factors can improve quality of care for CABG patients.
Objective:
Coronary artery bypass grafting is associated with significant interhospital variability in charges. Drivers of hospital charge variability remain elusive. We identified modifiable factors associated with statewide interhospital variability in hospital charges for coronary artery bypass grafting.
Methods:
Charge data were used as a surrogate for cost. Society of Thoracic Surgeons data from Maryland institutions and charge data from the Maryland Health Care Commission were linked to characterize interhospital charge variability for coronary artery bypass grafting. Multivariable linear regression was used to identify perioperative factors independently related to coronary artery bypass grafting charges. Of the factors independently associated with charges, we analyzed which factors varied between hospitals.
Results:
A total of 10,337 patients underwent isolated coronary artery bypass grafting at 9 Maryland hospitals from 2012 to 2016, of whom 7532 patients were available for analyses. Mean normalized charges for isolated coronary artery bypass grafting varied significantly among hospitals, ranging from $30,000 to $57,000 (P < .001). Longer preoperative length of stay, operating room time, and major postoperative morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection were associated with greater hospital charges. Incidence of major postoperative events, except stroke and deep sternal wound infection, was variable between hospitals. In a univariate linear regression model, patient risk profile only accounted for approximately 10% of statistical variance in charges.
Conclusions:
There is significant charge variability for coronary artery bypass grafting among hospitals within the same state. By targeting variation in preoperative length of stay, operating room time, postoperative renal failure, prolonged ventilation, and reoperation, cardiac surgery programs can realize cost savings while improving quality of care for this resource-intense patient population.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
11:58Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease I: Introduction
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:26Coronary Artery Disease IV: Preventive Measures
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...