A Cost Analysis of Nonelective Coronary Artery Bypass Graft Surgery

Violette, Philippe D.; Filion, Kristian B.; Haider, Seema; Pilote, Louise; Eisenberg, Mark J.

doi:10.1111/j.1540-8191.2006.00315.x

Cited by 13 publications

(5 citation statements)

References 16 publications

(26 reference statements)

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“…One of the reasons for higher cost was a higher prevalence of urgent cases in the EF ≤20% subgroup, which has been shown to carry a significantly higher cost of care. 18 Analysis of the Pennsylvania Health Care Cost Containment Council database demonstrated that higher observed to expected ratios for operative mortality were associated with increased costs. 19 Other groups also showed that increased mortality is associated with increased cost in isolated CABG.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Direct Cost of Isolated Nonemergent CABG in Patients With Low Ejection Fraction

Gulkarov,

Salemi,

Pawlikowski

et al. 2023

Innovations�(Phila)

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Objective: Preoperative left ventricular ejection fraction (LVEF) is one of the main predictors of outcomes in cardiac surgery. We present current era outcomes and associated direct cost in nonemergent isolated coronary artery bypass surgery (CABG) patients with LVEF <20% over the past 6 years and compare it with higher EF subgroups. Methods: Six-year data from 2016 to 2022 at hospitals sharing Society of Thoracic Surgeons and financial data with Biome Analytics were analyzed based on 3 EF subgroups (EF ≤20%, EF 21% to 35%, and EF >35%). Outcomes and costs were assessed. Results: Overall 30-day mortality of 12,649 patients was 1.9%. The EF ≤20% ( n = 248), EF 21% to 35% ( n = 1,408), and EF >35 ( n = 10,993) cohorts had mortality of 6.9%, 3.7%, and 1.6%, respectively. The EF ≤20% subgroup had higher use of cardiopulmonary bypass, blood products, and mechanical support. In addition, the EF ≤20% subgroup had higher complication rates in almost all measured categories. Also, the EF ≤20% cohort had significantly higher length of stay, intensive care unit (ICU) hours, ICU and hospital readmissions, and lowest discharge to home rate. The strongest factors associated with mortality were postoperative cardiac arrest, renal failure requiring dialysis, extracorporeal membrane oxygenation, sepsis, prolonged ventilation, and gastrointestinal event. The overall median direct cost of care was $37,387.79 ($27,605.18, $51,720.96), with a median direct cost of care in the EF ≤20%, EF 21% to 35%, and EF >35% subgroups of $52,500.17 ($34,103.52, $80,806.79), $44,108.32 ($31,597.58, $63,788.03), and $36,521.80 ($27,168.91, $50,019.31), respectively. Conclusions: In nonemergent isolated CABG surgery, low EF continues to have higher surgical risks and higher direct cost of care despite advances in cardiovascular care.

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Section: Discussionmentioning

confidence: 99%

Outcomes and Direct Cost of Isolated Nonemergent CABG in Patients With Low Ejection Fraction

Gulkarov,

Salemi,

Pawlikowski

et al. 2023

Innovations�(Phila)

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“…According to prior studies (Cota and others 2005; Ferrante and others 2015; Haider and others 2015; Kurki and others 2003; Kwok and others 2011; Violette and others 2006), index admissions were classified into four mutually exclusive groups based on the type of hospitalization: elective major surgery, non-elective major surgery, critical illness, and other. Major surgery was defined using a restricted set of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes for surgeries occurring in an operating room, as described in an earlier report (Kwok and others 2011).…”

Section: Methodsmentioning

confidence: 99%

The subsequent course of disability in older persons discharged to a skilled nursing facility after an acute hospitalization

Liu

Han

Gahbauer

et al. 2017

Experimental Gerontology

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Objectives To evaluate the association between the type of acute hospitalization and subsequent course of disability in older persons discharged to a skilled nursing facility (SNF). Design Longitudinal study of 754 community-living persons aged 70 or older. Participants The analytical sample included 365 participants who had one or more admissions to a SNF after an acute hospitalization (n=520 index admissions). Measurements Information on hospitalizations, SNF admissions, and disability was ascertained over 15 years. The primary and secondary outcomes were disability burden and recovery of prehospital function, respectively, assessed monthly over a 6-month period. Index admissions were classified into four mutually exclusive groups based on the type of hospitalization: elective major surgery, non-elective major surgery, critical illness, and other. Results Disability worsened considerably after hospitalization for each of the four groups. Relative to elective major surgery, the disability burden over 6 months was significantly greater for non-elective major surgery, critical illness, and other hospitalizations, with adjusted rate ratios (RRs) of 1.37 (95% CI 1.19 to 1.59), 1.37 (95% CI 1.19 to 1.58), and 1.29 (95% CI 1.14 to 1.47), respectively. Overall, recovery to pre-hospital function was observed in only 132 (25.4%) admissions. Relative to elective major surgery, the likelihood of recovering pre-hospital function was considerably lower for each of the three other groups. The results were consistent for basic, instrumental and mobility activities. Conclusion Among older persons discharged to a SNF after an acute hospitalization, the functional course over 6 months was generally poor, with recovery to pre-hospital function observed in only one out of every four cases. Relative to elective major surgery, functional outcomes were worse for non-elective major surgery, critical illness, and other hospitalizations.

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“…[63][64][65][66][67][68] Although a clopidogrel washout period decreases bleeding risk, it is associated with an ϳ1% increase in reinfarction, 67,69 and increased costs because of prolonged hospital stay. 70 The ACC/AHA guidelines for both UA/NSTEMI and STEMI recommend clopidogrel cessation 5 to 7 days before CABG, unless the need for revascularization outweighs the risk of bleeding. 2,3 The recommendation to withhold clopidogrel 5 to 7 days before CABG leads many physicians to delay clopidogrel administration until after coronary angiography, which is a determinant of the need for CABG.…”

Section: Barriers To Dual Antiplatelet Therapymentioning

confidence: 99%

Clopidogrel in the Management of Acute Coronary Syndromes

Amsterdam

2009

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Atherothrombosis is the underlying pathology of the acute coronary syndromes (ACS), in which platelet activation plays a key role. Therefore, antiplatelet therapy is an essential component of guideline-recommended ACS management. Considerable evidence clearly demonstrates the benefits of the antiplatelet agent clopidogrel in reducing mortality, decreasing recurrent cardiovascular events, and increasing arterial patency in ACS patients. Despite this evidence, data from patient registries and clinical initiatives such as CRUSADE (Can Rapid stratification of Unstable angina Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines) and GRACE (Global Registry of Acute Coronary Events) indicate that clopidogrel is underused in patients with ACS. This is especially true for patients receiving conservative medical management, many of whom have significant risk for recurrent ischemic events. The purpose of this review is to compare "real-life" clopidogrel therapy with evidence-based guidelines, and to highlight clinical factors that drive clopidogrel implementation or provide barriers to its use in ACS patients.

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A Cost Analysis of Nonelective Coronary Artery Bypass Graft Surgery

Cited by 13 publications

References 16 publications

Outcomes and Direct Cost of Isolated Nonemergent CABG in Patients With Low Ejection Fraction

Outcomes and Direct Cost of Isolated Nonemergent CABG in Patients With Low Ejection Fraction

The subsequent course of disability in older persons discharged to a skilled nursing facility after an acute hospitalization

Clopidogrel in the Management of Acute Coronary Syndromes

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