Cost Containment and Coronary Artery Surgery

Loop and co-workers, in this issue ofThe Journal(p 63), describe studies in which they have been able to achieve major savings for patients undergoing coronary artery bypass graft (CABG) by a reassessment of the entire operative experience. By carrying out workups on an outpatient basis and admitting patients on the day of surgery, by decreasing special care unit time by one day, by not performing routine blood cross-match, and by not using preoperative Swan-Ganz catheters in uncomplicated cases, they have documented unit cost savings for their patients. By contrasting the group of Cleveland Clinic patients who were admitted on the day of surgery with another group with the usual two preoperative days in the hospital, they show that at least $1,000 per case has been saved in 1977 constant dollars. This work confirms and extends the 1979 study of Tomatis et al,1who demonstrated for CABG in