非选择性冠状动脉搭桥手术的成本分析

Violette Philippe D, Filion Kristian B, Haider Seema, Pilote Louise, Eisenberg Mark J

Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.

J Card Surg. 2006 Nov-Dec;21(6):621-7. doi: 10.1111/j.1540-8191.2006.00315.x.

BACKGROUND

Previous studies suggest that nonelective coronary artery bypass graft surgery (CABG) is more costly than elective CABG. The goal of this study was to examine why cost differences exist between patients undergoing nonelective and elective CABG.

METHODS

We compared the outcomes and costs of treating 1613 consecutive patients undergoing nonelective (N = 1071) and elective (N = 542) CABG at three U.S. hospitals. Participating centers each used the same cost accounting system to provide patient-level clinical and cost data. Total, direct, and overhead costs were examined as were department-level costs.

RESULTS

Compared to elective patients, nonelective patients were of similar age (66.4 years vs 67.0 years, respectively, p = NS), but were more likely to be female (32.7% vs 24.0%, p = 0.0003). Nonelective patients had longer lengths of stay (LOS) than elective patients (9.7 +/- 0.2 days vs 6.6 +/- 0.3 days, p < 0.0001). The longer LOS among nonelective patients was primarily due to a longer preoperative LOS (2.6 +/- 0.08 days vs 0.4 +/- 0.05 days). Unadjusted in-hospital costs of treatment were 38% higher among nonelective patients ($25,111 +/-$550 vs $18,445 +/-$752, p < 0.0001). After controlling for baseline demographic and clinical differences, the increase in cost among nonelective patients was reduced to 33% (cost ratio = 1.33, 95% confidence interval = 1.27 to 1.39, p < 0.0001). The difference in cost among nonelective patients was further reduced to 16% after controlling for rates of preoperative angiography and percutaneous coronary intervention (PCI), 14% after adjusting for the use of a pacemaker or a balloon pump, and 7% after adjusting for preoperative LOS.

CONCLUSIONS

Patients undergoing nonelective CABG have longer LOS and higher costs than patients undergoing elective CABG. The increased cost among nonelective patients is largely due to differences in rates of preoperative LOS, angiography, and PCI. This differential reflects increased nonsurgical costs among patients undergoing nonelective CABG rather than surgical costs.

背景

先前的研究表明，非选择性冠状动脉旁路移植术（CABG）比选择性CABG成本更高。本研究的目的是探讨接受非选择性和选择性CABG的患者之间存在成本差异的原因。

方法

我们比较了美国三家医院连续接受非选择性（N = 1071）和选择性（N = 542）CABG的1613例患者的治疗结果和成本。参与研究的中心均使用相同的成本核算系统来提供患者层面的临床和成本数据。对总费用、直接费用和间接费用以及科室层面的费用进行了检查。

结果

与选择性手术患者相比，非选择性手术患者年龄相仿（分别为66.4岁和67.0岁，p =无统计学意义），但女性比例更高（32.7%对24.0%，p = 0.0003）。非选择性手术患者的住院时间（LOS）比选择性手术患者更长（9.7±0.2天对6.6±0.3天，p < 0.0001）。非选择性手术患者较长的住院时间主要是由于术前住院时间更长（2.6±0.08天对0.4±0.05天）。非选择性手术患者未经调整的住院治疗费用高出38%（25,111±550美元对18,445±752美元，p < 0.0001）。在控制了基线人口统计学和临床差异后，非选择性手术患者的成本增加降至33%（成本比 = 1.33，95%置信区间 = 1.27至1.39，p < 0.