Predictors of increased costs following index adult cardiac operations: Insights from a statewide publicly reported registry

Abstract

Background The aim of this study was to identify hospital‐level predictors of increased cost following index adult cardiac operations in a statewide registry. Methods The Pennsylvania Health Care Cost Containment Council (PHC4) database was queried for isolated coronary artery bypass grafting (CABG), isolated valve surgery, or CABG plus valve surgery performed between 2014 and 2016. Charge‐to‐cost ratios for each individual hospital were used to estimate cost. Expected (predicted) operative mortality and 30‐day readmission were evaluated using multivariable risk models and linear regression analysis was utilized to evaluate the risk‐adjusted impact of multiple hospital‐level characteristics on costs. Results During the study period, 29 578 patients underwent isolated CABG (n = 16,641), isolated valve surgery (n = 8618), or CABG plus valve surgery (n = 4319) at 60 hospitals. The median cost of CABG was $61 573 (interquartile range [IQR] $50 780 to $77 482). The median cost of isolated valve surgery was $68,835 (IQR $56 039 to $89 465) and CABG plus valve surgery $83 574 (IQR $69 806 to $114 407). Hospital‐level predictors of increasing costs in isolated CABG included higher predicted mortality rates, higher observed‐to‐expected (OE) mortality ratios, and nonteaching status. No hospital‐level independent predictors of increased costs were identified for isolated valve or CABG plus valve surgery. Conclusions Hospitals that performed higher risk cases and had higher OE ratios for operative mortality in isolated CABG were found to have increased costs. These data collectively suggest that attention to risk assessment and outcome optimization efforts in isolated CABG would likely result in programmatic advantages not only from a clinical standpoint but also economic.

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

“…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. 20,21 These reports, like our study, showed that higher mortality is associated with a higher incidence of postoperative complications, which also leads to increased inpatient direct cost.…”

A Risk Prediction Model of Readmission after coronary artery bypass grafting (CABG) in China

“…In 2015, CABG was included in the US Hospital Readmission Reduction Program [15] , since then, many scholars have studied the risk factors associated with postoperative readmission in patients after CABG, such as obstructive pulmonary disease, anemia, cirrhosis, and infection at the surgical site [1,16] . There are also studies showed that readmission after cardiac surgery are related to the additional cost of surgery [17][18] . In 2017, Aleksander and other scholars used American patient data to establish a RAC risk assessment scale, which included 6 items: age, gender, race, insurance, type of admission, and complications [8] .…”

Outcomes With Heparin-Induced Thrombocytopenia After Cardiac Surgery

“…6,9 Nevertheless HIT has been associated with greater healthcare cost and utilization. 7,10 As such, HIT remains an important complication after cardiac surgery and may represent an area for quality improvement.…”