Economic Burden of Multiple Organ Dysfunction Syndrome after Cardiac Surgery with Cardiopulmonary Bypass: A Retrospective Cohort Study

Objective: To assess the economic burden and resource utilization associated with an increasing number of postoperative organ dysfunctions defined according to the SOFA score after cardiac surgery with cardiopulmonary bypass (CPB). Materials and methods: This single-center retrospective cohort study included 681 adult patients who underwent cardiac surgery with CPB in 2025. The primary analysis included 676 patients with complete data for the assessment of organ dysfunction during the first 72 h after surgery. Organ dysfunction was assessed using the original SOFA score, and patients were stratified into groups with no organ dysfunction, dysfunction of one organ system, and multiple organ dysfunction syndrome (MODS), defined as dysfunction of two or more organ systems. Resource utilization, in-hospital mortality, and direct medical costs calculated using a micro-costing approach were assessed. A generalized linear model with a gamma distribution and log link was used to evaluate independent associations with costs. The robustness of the findings was assessed in sensitivity analyses using the maximum SOFA score throughout the ICU stay and after excluding patients with preoperative organ dysfunction. Results: During the first 72 h after surgery, dysfunction of one organ system was identified in 11.2% (76/676) of patients, and MODS occurred in 6.1% (41/676). The length of ICU stay increased from 2 [2; 3] days in patients without organ dysfunction to 4 [3; 7] days in those with single-organ dysfunction and 8 [5; 17] days in those with MODS ( p < 0.001). Patients with MODS accounted for 66.7% of all in-hospital deaths (4/6). The median total hospitalization cost was 125 [107; 146], 285 [235; 355], and 640 [465; 910] thousand RUB, respectively ( p < 0.001 for all pairwise comparisons). After adjustment for age, EuroSCORE II, urgency and type of surgery, CPB duration, and preoperative organ dysfunction, MODS was independently associated with higher hospitalization costs (Cost Ratio 3.1; 95% CI, 2.4–4.0; p < 0.001). In the MODS group, 60.2% of total costs were attributable to ICU stay. When the maximum SOFA score throughout the ICU stay was used, the incidence of MODS was 7.3%, and the Cost Ratio was 3.3 (95% CI, 2.6–4.3). Conclusion: An increasing number of postoperative organ dysfunctions was associated with progressively greater resource utilization and hospitalization costs. Despite its relatively low incidence, MODS was characterized by disproportionately high resource utilization and remained independently associated with higher costs after adjustment for baseline severity and surgical characteristics. These findings highlight the economic importance of preventing and reducing the severity of postoperative organ dysfunction.