Cost of individual complications following coronary artery bypass grafting

Mehaffey, J. Hunter; Hawkins, Robert B.; Byler, Matthew R.; Charles, Eric J.; Fonner, Clifford E.; Krön, Irving L.; Quader, Mohammed; Speir, Alan M.; Rich, Jeff; Ailawadi, Gorav; Initiative, Virginia Cardiac Services Quality

doi:10.1016/j.jtcvs.2017.08.144

Cited by 77 publications

(57 citation statements)

References 22 publications

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“…Several studies have identified postoperative complications and resource utilisation as the largest drivers of healthcare cost 42–44. To offer optimal value in healthcare we must provide the highest quality care at the lowest cost.…”

Section: Discussionmentioning

confidence: 99%

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

et al. 2019

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BackgroundSocioeconomic status affects surgical outcomes, however these factors are not included in clinical quality improvement data and risk models. We performed a prospective registry analysis to determine if the Distressed Communities Index (DCI), a composite socioeconomic ranking by zip code, could predict risk-adjusted surgical outcomes and resource utilisation.MethodsAll patients undergoing surgery (n=44,451) in a regional quality improvement database (American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP) were paired with DCI, ranging from 0–100 (low to high distress) and accounting for unemployment, education level, poverty rate, median income, business growth and housing vacancies. The top quartile of distress was compared to the remainder of the cohort and a mixed effects modeling evaluated ACS-NSQIP risk-adjusted association between DCI and the primary outcomes of surgical complications and resource utilisation.ResultsA total of 9369 (21.1%) patients came from severely distressed communities (DCI >75), who had higher rates of most medical comorbidities as well as transfer status (8.4% vs 4.8%, p<0.0001) resulting in higher ACS-NSQIP predicted risk of any complication (8.0% vs 7.1%, p<0.0001). Patients from severely distressed communities had increased 30-day mortality (1.8% vs 1.4%, p=0.01), postoperative complications (9.8% vs 8.5%, p<0.0001), hospital readmission (7.7 vs 6.8, p<0.0001) and resource utilisation. DCI was independently associated with postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p<0.0001) as well as resource utilisation after adjusting for ACS-NSQIP predicted riskConclusionIncreasing Distressed Communities Index is associated with increased postoperative complications and resource utilisation even after ACS-NSQIP risk adjustment. These findings demonstrate a disparity in surgical outcomes based on community level socioeconomic factors, highlighting the continued need for public health innovation and policy initiatives.

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Section: Discussionmentioning

confidence: 99%

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

et al. 2019

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“…The VCSQI database (ARMUS Corporation, San Mateo, CA) captures STS demographic, preoperative, clinical, and 30-day outcomes data on patients who undergo cardiac surgery at 18 centers in Virginia and 1 center in North Carolina. [19] Cost data derived from Uniform Billing-04 files, which identifies charges classified by International Classification of Diseases ninth revision-based revenue codes, are matched to STS data. [20] Costs are estimated using cost-to-charge ratios submitted to Centers for Medicare and Medicaid Services.…”

Section: Study Populationmentioning

confidence: 99%

Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery

Charles

Mehaffey

Hawkins

et al. 2019

The Annals of Thoracic Surgery

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Background: The effects of socioeconomic factors other than insurance status and race on outcomes following cardiac surgery are not well understood. We hypothesized that the Distressed Communities Index (DCI), a comprehensive socioeconomic ranking by zip code, would predict operative mortality following coronary artery bypass grafting (CABG). Methods: All patients who underwent isolated CABG (2010-2017) in the Virginia Cardiac Services Quality Initiative database were analyzed. The DCI accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies, with scores ranging from 0 (no distress) to 100 (severe distress). Patients were stratified by DCI quartiles (I: 0-24.9, II: 25-49.9, III: 50-74.9, IV: 75-100) and compared. Hierarchical linear regression modeled the association between DCI and mortality. Results: A total of 19,756 CABG patients were analyzed, with mean PROM of 2.0±3.5%. Higher DCI scores were associated with increasing PROM. Overall operative mortality was 2.1% [n=424] and increased with increasing DCI quartile (I: 1.6% [95], II: 2.1% [77], III: 2.4% [114],

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“…[1][2][3][4] Negative pressure wound therapy 3,5,6 and advances in reconstructive surgery of the sternum may improve the outcome of patients with postoperative DSWI, 7,8 but hospital and late mortality in these patients remains nonnegligible. [9][10][11][12][13] Furthermore, the financial burden associated with the treatment of sternal wound complications is relevant due to the direct costs incurred by the related prolonged therapies and hospital stay. 9,10,14 In this context, effective preventive strategies along with a tailored method of DSWI risk stratification are of utmost importance.…”

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confidence: 99%

“…[9][10][11][12][13] Furthermore, the financial burden associated with the treatment of sternal wound complications is relevant due to the direct costs incurred by the related prolonged therapies and hospital stay. 9,10,14 In this context, effective preventive strategies along with a tailored method of DSWI risk stratification are of utmost importance. In particular, identification of high-risk patients is important when bilateral internal mammary artery (BIMA) grafting is planned because the risk of DSWI is higher with this technique.…”

mentioning

confidence: 99%

Preoperative risk stratification of deep sternal wound infection after coronary surgery

Biancari

Gatti

Rosato

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:To develop a risk score for deep sternal wound infection (DSWI) after isolated coronary artery bypass grafting (CABG).Design:Multicenter, prospective study.Setting:Tertiary-care referral hospitals.Participants:The study included 7,352 patients from the European multicenter coronary artery bypass grafting (E-CABG) registry.Intervention:Isolated CABG.Methods:An additive risk score (the E-CABG DSWI score) was estimated from the derivation data set (66.7% of patients), and its performance was assessed in the validation data set (33.3% of patients).Results:DSWI occurred in 181 (2.5%) patients and increased 1-year mortality (adjusted hazard ratio, 4.275; 95% confidence interval [CI], 2.804–6.517). Female gender (odds ratio [OR], 1.804; 95% CI, 1.161–2.802), body mass index ≥30 kg/m2 (OR, 1.729; 95% CI, 1.166–2.562), glomerular filtration rate <45 mL/min/1.73 m2 (OR, 2.410; 95% CI, 1.413–4.111), diabetes (OR, 1.741; 95% CI, 1.178–2.573), pulmonary disease (OR, 1.935; 95% CI, 1.178–3.180), atrial fibrillation (OR, 1.854; 95% CI, 1.096–3.138), critical preoperative state (OR, 2.196; 95% CI, 1.209–3.891), and bilateral internal mammary artery grafting (OR, 2.088; 95% CI, 1.422–3.066) were predictors of DSWI (derivation data set). An additive risk score was calculated by assigning 1 point to each of these independent risk factors for DSWI. In the validation data set, the rate of DSWI increased along with the E-CABG DSWI scores (score of 0, 1.0%; score of 1, 1.8%; score of 2, 2.2%; score of 3, 6.9%; score ≥4: 12.1%; P < .0001). Net reclassification improvement, integrated discrimination improvement, and decision curve analysis showed that the E-CABG DSWI score performed better than other risk scores.Conclusions:DSWI is associated with poor outcome after CABG, and its risk can be stratified using the E-CABG DSWI score.Trial registration:clinicaltrials.gov identifier: NCT02319083

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Cost of individual complications following coronary artery bypass grafting

Cited by 77 publications

References 22 publications

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery

Preoperative risk stratification of deep sternal wound infection after coronary surgery

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