Hospital Cost of Complications Associated With Coronary Artery Bypass Graft Surgery

Procedure-related costs are of increasing concern in selecting the appropriate treatment for coronary artery disease. 1 Smith LR Milano CA Molter BS Elberry JR Sabiston DC Preoperative determinants of postoperative costs associated with Coronary Artery Bypass Graft Surgery. Circulation. 1994; 90: II.124, II.128 Google Scholar Although coronary artery bypass graft (CABG) is a common and accepted mode of treatment, few hospital-based expenditure studies exist, and most have been conducted within a single hospital. 1 Smith LR Milano CA Molter BS Elberry JR Sabiston DC Preoperative determinants of postoperative costs associated with Coronary Artery Bypass Graft Surgery. Circulation. 1994; 90: II.124, II.128 Google Scholar , 2 Taylor GJ Mikell FL Mose W Dove JT Katholi RE Malik SA Markwell SJ Korsmeyer C Scheider JA Wellons HA Determinants of hospital charges for coronary artery bypass graft surgery: the economic consequences of postoperative complications. Am J Cardiol. 1990; 65: 309-313 Abstract Full Text PDF PubMed Scopus (178) Google Scholar , 3 Mauldin PD Weintraub WS Becker ER Predicting hospital costs for first time coronary artery bypass grafting from post-operative and pre-operative variables. Am J Cardiol. 1994; 74: 772-775 Abstract Full Text PDF PubMed Scopus (76) Google Scholar , 4 Krueger H Goncalves JL Caruth FM Hayden RI Coronary artery bypass grafting: how much does it cost?. Can Med Assoc J. 1992; 146: 163-168 Google Scholar , 5 Cohen DJ Breall JA Ho KKL Weintraub RM Kuntz RE Weinstein MC Baim D Economics of elective coronary revascularization. Comparison of costs and charges for conventional angioplasty, directional atherectomy, stenting and bypass surgery. J Am Coll Cardiol. 1993; 22: 1052-1059 Abstract Full Text PDF PubMed Scopus (142) Google Scholar , 6 Tierney WM Fitzgerald JF Miller ME James MK McDonald CJ Predicting inpatient costs with admitting clinical data. Med Care. 1995; 33: 1-14 Crossref PubMed Scopus (40) Google Scholar , 7 Peigh PS Swartz MT Vaca KJ Lohmann DP Naunhiem KS Effect of advancing age on cost and outcome of coronary artery bypass grafting. Ann Thorac Surg. 1994; 58: 1362-1367 Abstract Full Text PDF PubMed Scopus (40) Google Scholar Factors contributing to hospital costs in CABG are: (1) type of procedure(s) performed, (2) baseline clinical and other patient characteristics reflecting sickness at admission, (3) in-hospital mortality (a factor associated with high resource use), and (4) surgical complications. Although baseline characteristics affect total expenditures for CABG, surgical complications appear to contribute more. 2 Taylor GJ Mikell FL Mose W Dove JT Katholi RE Malik SA Markwell SJ Korsmeyer C Scheider JA Wellons HA Determinants of hospital charges for coronary artery bypass graft surgery: the economic consequences of postoperative complications. Am J Cardiol. 1990; 65: 309-313 Abstract Full Text PDF PubMed Scopus (178) Google Scholar Because patients who are sicker at baseline and have more procedures may experience more postoperative complications, both baseline patient status and extensiveness of procedure(s) should be considered as risk factors when assessing costs due to complications. 8 Iezzoni L Risk adjustment for medical effectiveness research: an overview of conceptual and methodological considerations. J Invest Med. 1995; 43: 136-150 PubMed Google Scholar We used a state-wide hospital discharge database to estimate the contribution of complications to the hospital cost of CABG. We converted “charges” to costs to more accurately reflect resource use. 5 Cohen DJ Breall JA Ho KKL Weintraub RM Kuntz RE Weinstein MC Baim D Economics of elective coronary revascularization. Comparison of costs and charges for conventional angioplasty, directional atherectomy, stenting and bypass surgery. J Am Coll Cardiol. 1993; 22: 1052-1059 Abstract Full Text PDF PubMed Scopus (142) Google Scholar , 9 Shwartz M Young DW Siegrist R The ratio of costs to charges: how good a basis for estimating costs?. Inquiry. 1995; 32: 476-481 PubMed Google Scholar , 10 Finkler SA The distinction between cost and charges. Ann Intern Med. 1992; 96: 102-109 Crossref Scopus (971) Google Scholar