The frequency and cost of complications associated with coronary artery bypass grafting surgery: Results from the United States Medicare program
The frequency and cost of complications associated with coronary artery bypass grafting surgery: Results from the United States Medicare program
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DOI：
10.1016/j.athoracsur.2008.01.053
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发表时间：
2008-06-01
影响因子：
4.6
通讯作者：
Simon, April W.
中科院分区：
文献类型：
--
作者：
Brown, Phillip P.;Kugelmass, Aaron D.;Simon, April W.
背景。我们估计增加的医院资源消耗与治疗选择并发症的医疗保险受益人接受冠状动脉旁路移植术（CABG）。这项回顾性研究，使用医疗保险提供者分析和审查文件，确定了114,233名在2005财政年度住院期间没有合并瓣膜修复的CABG存活的医疗保险受益人。观察出血或术后休克、再手术、术后成人呼吸窘迫综合征、新发血液透析、术后卒中、术后感染、败血症等7种并发症的发生率。评估了观察到的和调整后的治疗出现每种选定并发症的受益人所消耗的增量医院资源（成本和住院时间）。在医疗保险受益人中，与冠脉搭桥手术相关的平均住院费用为32,201美元+/- 23,059美元，平均住院时间为9.9 +/- 7.8天。在对患者人口统计学和合并症进行调整后，13.64%的医疗保险受益人经历了任何研究并发症，消耗了更多的医院资源（增量成本，15,468美元），住院时间更长（增量住院时间，5.3天）。尽管预后不断改善，但旁路移植术后的主要并发症仍然很常见，并大大增加了这些手术的医院费用。这些发现表明，重新分配目前用于治疗并发症的资源可能节省的成本，将有助于为投资于患者安全倡议和最佳实践指南提供“商业案例”，以减少选定的并发症。
Background. We estimate the incremental hospital resource consumption associated with treating selected complications experienced by Medicare beneficiaries undergoing coronary artery bypass grafting (CABG).Methods. This retrospective study, using the Medicare Provider Analysis and Review file, identified 114,233 Medicare beneficiaries who survived CABG without concomitant valve repair during a hospitalization for fiscal year 2005. The frequencies of seven complications were determined: hemorrhage or postoperative shock, reoperation, postoperative adult respiratory distress syndrome, new-onset hemodialysis, postoperative stroke, postoperative infection and septicemia. The observed and adjusted incremental hospital resources consumed (cost and length-of-stay) in treating beneficiaries experiencing each of the selected complications were estimated.Results. The mean cost of a hospitalization associated with a CABG procedure among Medicare beneficiaries was $32,201 +/- $23,059, and the mean length of stay was 9.9 +/- 7.8 days. After adjusting for patient demographics and comorbid conditions, the 13.64% of Medicare beneficiaries experiencing any of the study complications consumed significantly more hospital resources (incremental cost, $15,468) and had a longer length of stay (incremental stay, 5.3 days).Conclusions. Despite ongoing improvements in outcomes, major complications remain common after bypass grafting and add substantially to hospital costs for these procedures. These findings suggest that the potential cost savings of redirecting resources currently spent on treating complications will help make the "business case" for investing in patient safety initiatives and best practices guidelines shown to reduce selected complications.