Determinants of costs and resource utilization associated with open heart surgery

Sokolovic, E.; Schmidlin, Daniel; Schmid, Eckhard; Turina, Marko; Ruef, C.; Schwenkglenks, Matthias; Szucs, Thomas D.

doi:10.1053/euhj.2001.3031

Cited by 21 publications

(15 citation statements)

References 14 publications

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“…Recent studies with the EuroSCORE found a direct correlation between this risk model and hospital cost [5-7]. The p -values of the linear regression analysis were highly significant in all three studies (p < 0.0001).…”

Section: Discussionmentioning

confidence: 66%

Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients

Badreldin

Doerr

Kroener

et al. 2013

J Cardiothorac Surg

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BackgroundPreoperative risk stratification models have previously been suggested to predict cardiac surgery unit costs. However, there is a lack of consistency in their reliability in this field. In this study we aim to test the correlation between the values of six commonly known preoperative scoring systems and evaluate their reliability at predicting unit costs of cardiac surgery patients.MethodsOver a period of 14 months all consecutive adult patients undergoing cardiac surgery on cardiopulmonary bypass were prospectively classified using six preoperative scoring models (EuroSCORE, Parsonnet, Ontario, French, Pons and CABDEAL). Transplantation patients were the only patients we excluded. Total hospital costs for each patient were calculated independently on a daily basis using the bottom up method. The full unit costs were calculated including preoperative diagnostic tests, operating room cost, disposable materials, drugs, blood components as well as costs for personnel and fixed hospital costs. The correlation between hospital cost and the six models was determined by linear regression analysis. Both Spearman’s and Pearson’s correlation coefficients were calculated from the regression lines. An analysis of residuals was performed to determine the quality of the regression.ResultsA total of 887 patients were operated on for CABG (n = 608), valve (n = 142), CABG plus valve (n = 100), thoracic aorta (n = 33) and ventricular assist devices (n = 4). Mean age of the patients was 68.3±9.9 years, 27.6% were female. 30-day mortality rate was 4.1%. Correlation between the six models and hospital cost was weak (Pearson’s: r < 0.30; Spearman’s: r < 0.40).ConclusionThe risk stratification models in this study are not reliable at predicting total costs of cardiac surgical patients. We therefore do not recommend their use for this purpose.

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Section: Discussionmentioning

confidence: 66%

Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients

Badreldin

Doerr

Kroener

et al. 2013

J Cardiothorac Surg

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“…Its prediction can lead to better patient understanding of the risks associated with the procedures and may also aid decision-making behavior of clinicians and serve as a guide for hospital oversight to allocate resources efficiently and maximize care for high-risk patients. 1 Several tools have been developed in recent years, and among them the widest diffusion in the European countries has been reached by additive and logistic euroSCOREs. 2 These algorithms, however, have been demonstrated to be no more than adequate in the modern surgical population, with a high risk of overestimation.…”

Section: Discussionmentioning

confidence: 99%

Reliability of new scores in predicting perioperative mortality after mitral valve surgery

Barili

Pacini

Grossi

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Besides prediction of 30-day mortality, it has been demonstrated that the EuroSCORE model is also predictive for long-term mortality, specific postoperative complications, long-term health-related quality of life, as well as direct operative costs in patients undergoing cardiac surgery [3,9,23,24]. Furthermore, the EuroSCORE model has been used to estimate changes in patients risk profile over time [25].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increasing number of elderly and multi-morbid patients, in-hospital mortality in cardiac surgery remained unchanged or could be reduced [1]. In consequence, a higher rate of postoperative morbidity is associated with prolonged ICU LOS and, in this clinical setting, with a remarkable increase of individual health care costs per patient [2][3][4]. Therefore, optimal utilization of a hospital's resources becomes more and more important.…”

Section: Introductionmentioning

confidence: 99%

Does EuroSCORE Predict intensity of Postoperative Care and Rehabilitation Parameters? A Prospective Evaluation

Göber

Fah²,

Keller³

et al. 2014

Int J Phys Med Rehabil

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Objective: An increasing number of elderly and multi-morbid patients undergo cardiac surgery which results in increased postoperative morbidity, prolonged Intensive Care Unit (ICU) length of stay (LOS) and higher hospital costs. We aimed to evaluate the model of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the prediction of ICU LOS, hospital LOS, required daily nursing effort, and the type of cardiac rehabilitation.Methods: Prospective observational evaluation of 505 consecutive adult patients (mean age 65.1 ± 12.1 years, 25.7% female) who underwent cardiac and/or thoracic aortic thoracic surgery with Cardiopulmonary Bypass (CPB).Results: Median additive and logistic EuroSCORE was 5 (Interquartile Range (IQR) 3-7) and 5.8 (IQR 2.6-14.1), respectively. In univariate analysis both additive and logistic EuroSCORE were significantly associated with prolonged ICU LOS, prolonged hospital LOS, higher daily nursing effort, and the type of cardiac rehabilitation (inpatient versus outpatient), p<0.001 for all correlations.Multivariate analysis including other clinically relevant variables (CPB duration, type of operation, age, Body Mass Index (BMI), urgency of surgery, Left Ventricular Ejection Fraction (LVEF)) showed higher additive EuroSCORE and higher logistic EuroSCORE, independently associated with prolonged ICU LOS, prolonged hospital LOS, and higher daily nursing effort. However, EuroSCORE did not independently predict the type of rehabilitation. Conclusion:The EuroSCORE model can be used to identify patients with elevated risk for prolonged ICU LOS, prolonged hospital LOS and higher intensity of postoperative workload, and it is predictive for the type of rehabilitation. This conclusion may contribute to optimize the management of hospital bed capacity as well as a systematic planning of ICU resources, postoperative nursing care and cardiac rehabilitation.

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Determinants of costs and resource utilization associated with open heart surgery

Abstract: These results suggest that both pre-operative (patient related) and intra-operative (therapy- and patient-related) variables are predictors of costs in cardiac surgical patients.

Cited by 21 publications

References 14 publications

Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients

Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients

Reliability of new scores in predicting perioperative mortality after mitral valve surgery

Does EuroSCORE Predict intensity of Postoperative Care and Rehabilitation Parameters? A Prospective Evaluation

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