Health Care Costs and Financing

Both patient and hospital factors drive discharge costs of coronary artery bypass graft surgery

Nearly half a million coronary artery bypass graft (CABG) surgeries were performed in the United States in 2005. Several patient and hospital factors drive CABG discharge costs, reveals a new study. It found that older patient age, female gender, and being black were linked with higher costs. Also, lower cardiac ejection fraction (indicating lower pumping power of the heart), longer time between heart attack and CABG hospital admission, greater number of diseased coronary vessels, previous open heart operations, and a number of coexisting illnesses besides heart disease were all linked to higher CABG discharge costs. Understanding the differential impact of these patient risk factors can aid in cost containment efforts, suggests Shadi S. Saleh, Ph.D., M.P.H., of the State University of New York at Albany.

For example, certain interventions can be implemented to reduce risk among patients with specific preoperative characteristics. Dr. Saleh's team also linked several hospital characteristics to higher CABG discharge costs. Larger hospitals had higher CABG discharge costs, perhaps because many of them were teaching hospitals that typically have higher costs than nonteaching hospitals. On the other hand, CABG discharge costs significantly declined with greater hospital CABG volume (250 or more CABG procedures each year). The researchers suggest that providers could enhance efficiency by attracting more CABG procedures to their facility. They note that payers may reward (for example, selectively contract) high-volume and consequently lower-cost hospitals as part of implementing a value-based purchasing system.

Other factors such as hospital staffing and operating room scheduling may affect CABG discharge costs, but these were not studied. These findings were based on analysis of data in the New York State Cardiac Surgery Reporting System, American Hospital Association data, and Medicare data. The study population included 12,016 adults who underwent CABG in a New York hospital and were discharged in 2003. The study was supported in part by the Agency for Healthcare Research and Quality (HS15751). More details are in "The effect of preoperative and hospital characteristics on costs for coronary artery bypass graft," by Dr. Saleh, Michael Racz, Ph.D., and Edward Hannan, Ph.D., in the February 2009 Annals of Surgery 249(2), pp. 335-341.

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