Preoperative predictors of cost in Medicare-age patients undergoing coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Health Economics
• Biostatistics

Background:

• Coronary artery bypass grafting (CABG) costs vary significantly.
• Identifying preoperative predictors of CABG expenditure is crucial for healthcare cost management.
• Understanding cost drivers can improve financial forecasting and resource allocation in cardiac surgery.

Purpose of the Study:

• To identify sociodemographic and clinical preoperative factors associated with total hospital costs for coronary artery bypass grafting.
• To apply survival analysis techniques to determine predictors of cost in elderly patients undergoing CABG.
• To establish a framework for analyzing healthcare costs in other surgical patient cohorts.

Main Methods:

• Utilized a cohort of 757 patients aged 65 or older undergoing isolated CABG between July 1993 and April 1995.
• Developed custom hospital database software to calculate total hospital cost as the outcome variable.
• Employed nonparametric methods for univariate analysis and the Cox proportional hazards model for multivariable analysis, with censoring for in-hospital deaths.

Main Results:

• The median hospital cost for CABG was $15,198, with a median postoperative length of stay of 6 days.
• Multivariable analysis identified independent predictors of total cost: patient age, preoperative renal failure, history of cerebrovascular accident, low ejection fraction, and surgical urgency.
• These factors significantly influenced the overall financial burden of the procedure.

Conclusions:

• The study provides an accurate model for analyzing hospital costs in CABG patients, accounting for in-hospital mortality.
• Identified preoperative factors serve as valuable predictors for the total cost of coronary artery bypass grafting.
• The methodology can be adapted to analyze cost drivers in other complex surgical populations.