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Predicting hospital costs for first-time coronary artery bypass grafting from preoperative and postoperative
P D Mauldin1, W S Weintraub, E R Becker
1School of Public Health, Emory University, Atlanta, GA.
Insights
Predicting hospital costs after coronary artery bypass grafting (CABG) is crucial. Preoperative factors and postoperative complications significantly increase costs, with no complications costing an average of $16,776.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Medical Informatics
Background:
- Hospital costs following coronary artery bypass grafting (CABG) vary significantly.
- Predictive models are needed to understand cost determinants.
Purpose of the Study:
- To identify preoperative characteristics and postoperative complications that predict hospital costs after CABG.
- To analyze the relationship between patient factors, complications, and resource utilization.
Main Methods:
- Four analyses were performed: univariate, multivariate preoperative, multivariate postoperative, and multivariate combined.
- Data from 807 patients undergoing first-time CABG at Emory University in 1990 were analyzed.
Main Results:
- Preoperative determinants of cost included higher angina grade, previous myocardial infarction, older age, congestive heart failure, and more diseased vessels.
- Postoperative complications significantly increasing costs included ARDS, IABP use, pneumonia, septicemia, major arrhythmia, reexploration for bleeding, and neurologic events.
- The mean cost for patients with no complications was $16,776.
Conclusions:
- Both preoperative patient characteristics and postoperative complications are significant predictors of hospital costs after CABG.
- Increased resource utilization is directly correlated with the number of postoperative complications.
- Understanding these cost drivers can inform resource allocation and cost-containment strategies in cardiac surgery.
Abstract:
To predict hospital costs after coronary artery bypass grafting (CABG) from preoperative characteristics and postoperative complications, 4 analyses of the data were used: (1) a univariate analysis of each preoperative and postoperative variable, (2) a multivariate analysis of the preoperative variables (model 1), (3) a multivariate analysis of the postoperative variables (model 2), and (4) a multivariate analysis of pre- and postoperative variables (model 3). Eight-hundred seven patients who underwent a first-time CABG at Emory University during 1990 were analyzed in this study. Using model 1, the determinants of costs were higher angina grade (p = 0.0006), previous myocardial infarction (p = 0.0133), older age (p = 0.0001), congestive heart failure (p = 0.0001), and a higher number of diseased vessels (p = 0.0001). For model 2, the determinants of costs were adult respiratory distress syndrome (p = 0.0073), intraaortic balloon pumping (p < 0.0001), pneumonia (p < 0.0001), septicemia p < 0.0001), major arrhythmia (p < 0.0001), reexploration for bleeding (p < 0.0001), wound infection (p = 0.0632), neurologic event (p = 0.0013), fluid overload (p = 0.0516), and absence of pericarditis (p = 0.0588). For univariate analysis, the determinants of increased costs were similar to those from models 1 and 2. Although there is considerable variance in hospital costs for any number of complications, utilized resources (costs) increase inexorably as patients have more complications after coronary surgery. The mean cost to the hospital for the 382 patients who underwent CABG and experienced no complications was $16,776.(ABSTRACT TRUNCATED AT 250 WORDS)