BACKGROUND: Complications after open-heart surgery result in an increased length of stay and greater financial burdens for all. The purpose of this study was to measure the additive costs of postoperative complications for selected subgroups of patients after coronary artery bypass grafts in the Commonwealth of Virginia. METHODS: A multiyear statewide data repository with clinical and billing data was used to measure outcomes for the period 2004 to 2007. The Society of Thoracic Surgeons records matched with Universal Billing (UB-04) charge data for all payers were used to estimate the additive costs of cardiac surgical outcomes using cost-to-charge ratios. Additive cost was defined as the difference between the baseline cost of an average case with no complications and one with a postoperative morbidity or mortality. Multivariate analysis was used to account for important covariates and apportion incremental costs. RESULTS: The baseline cost of isolated coronary artery bypass grafting (CABG) cases with no complications during the study period was $26,056. Isolated atrial fibrillation was the most frequently cited complication and had the lowest additive cost ($2,574). Additive costs for isolated CABG patients were greatest for those cases involving prolonged ventilation ($40,704), renal failure ($49,128), mediastinitis ($62,773), and operative mortality ($49,242). CONCLUSIONS: Additive costs can serve as an indicator for pursuing quality improvement initiatives. Our results suggest additive costs vary according to type of postoperative complication and comorbidities. Regional collaborations of multidisciplinary groups in cardiac surgery are an effective means to implement quality guidelines and drive down additive costs.
BACKGROUND: Complications after open-heart surgery result in an increased length of stay and greater financial burdens for all. The purpose of this study was to measure the additive costs of postoperative complications for selected subgroups of patients after coronary artery bypass grafts in the Commonwealth of Virginia. METHODS: A multiyear statewide data repository with clinical and billing data was used to measure outcomes for the period 2004 to 2007. The Society of Thoracic Surgeons records matched with Universal Billing (UB-04) charge data for all payers were used to estimate the additive costs of cardiac surgical outcomes using cost-to-charge ratios. Additive cost was defined as the difference between the baseline cost of an average case with no complications and one with a postoperative morbidity or mortality. Multivariate analysis was used to account for important covariates and apportion incremental costs. RESULTS: The baseline cost of isolated coronary artery bypass grafting (CABG) cases with no complications during the study period was $26,056. Isolated atrial fibrillation was the most frequently cited complication and had the lowest additive cost ($2,574). Additive costs for isolated CABG patients were greatest for those cases involving prolonged ventilation ($40,704), renal failure ($49,128), mediastinitis ($62,773), and operative mortality ($49,242). CONCLUSIONS: Additive costs can serve as an indicator for pursuing quality improvement initiatives. Our results suggest additive costs vary according to type of postoperative complication and comorbidities. Regional collaborations of multidisciplinary groups in cardiac surgery are an effective means to implement quality guidelines and drive down additive costs.
Authors: Kyriakos Anastasiadis; John Murkin; Polychronis Antonitsis; Adrian Bauer; Marco Ranucci; Erich Gygax; Jan Schaarschmidt; Yves Fromes; Alois Philipp; Balthasar Eberle; Prakash Punjabi; Helena Argiriadou; Alexander Kadner; Hansjoerg Jenni; Guenter Albrecht; Wim van Boven; Andreas Liebold; Fillip de Somer; Harald Hausmann; Apostolos Deliopoulos; Aschraf El-Essawi; Valerio Mazzei; Fausto Biancari; Adam Fernandez; Patrick Weerwind; Thomas Puehler; Cyril Serrick; Frans Waanders; Serdar Gunaydin; Sunil Ohri; Jan Gummert; Gianni Angelini; Volkmar Falk; Thierry Carrel Journal: Interact Cardiovasc Thorac Surg Date: 2016-01-26
Authors: Lily E Johnston; Emily A Downs; Robert B Hawkins; Mohammed A Quader; Alan M Speir; Jeffrey B Rich; Ravi K Ghanta; Leora T Yarboro; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2017-06-11 Impact factor: 4.330
Authors: Robert B Hawkins; J Hunter Mehaffey; Samuel M Kessel; Jolian J Dahl; Irving L Kron; John A Kern; Leora T Yarboro; Gorav Ailawadi Journal: J Thorac Cardiovasc Surg Date: 2018-04-03 Impact factor: 5.209
Authors: Terry Shih; Min Zhang; Mallika Kommareddi; Theodore J Boeve; Steven D Harrington; Robert J Holmes; Gary Roth; Patricia F Theurer; Richard L Prager; Donald S Likosky Journal: Circ Cardiovasc Qual Outcomes Date: 2014-07-01
Authors: Ravi K Ghanta; Damien J Lapar; John A Kern; Irving L Kron; Alan M Speir; Edwin Fonner; Mohammed Quader; Gorav Ailawadi Journal: J Thorac Cardiovasc Surg Date: 2015-01-12 Impact factor: 5.209
Authors: Robert B Hawkins; J Hunter Mehaffey; Abra Guo; Eric J Charles; Alan M Speir; Jeffrey B Rich; Mohammed A Quader; Gorav Ailawadi; Leora T Yarboro Journal: J Thorac Cardiovasc Surg Date: 2018-04-18 Impact factor: 5.209
Authors: J Hunter Mehaffey; Robert B Hawkins; Matthew Byler; Judy Smith; John A Kern; Irving Kron; Gorav Ailawadi; Tanya Wanchek; Leora T Yarboro Journal: Ann Thorac Surg Date: 2018-01-31 Impact factor: 4.330
Authors: Donald S Likosky; Amelia S Wallace; Richard L Prager; Jeffrey P Jacobs; Min Zhang; Steven D Harrington; Paramita Saha-Chaudhuri; Patricia F Theurer; Astrid Fishstrom; Rachel S Dokholyan; David M Shahian; J Scott Rankin Journal: Ann Thorac Surg Date: 2015-08-28 Impact factor: 4.330