Saleh Shadi S, Racz Michael, Hannan Edward
Department of Health Policy, Management, and Behavior, State University of New York at Albany, 12144, USA.
Ann Surg. 2009 Feb;249(2):335-41. doi: 10.1097/SLA.0b013e318195e475.
This study aimed at exploring the effect of preoperative risk factors and hospital characteristics on costs of coronary artery bypass graft (CABG) hospitalizations.
The considerable investment in hospital-based cardiac programs has not been coupled with comparable efforts to explore cost drivers of associated procedures.
Data sources included (a) New York State's Cardiac Surgery Reporting System, (b) New York State's Statewide Planning and Research Cooperative System dataset, (c) American Hospital Association dataset, and (d) Medicare Hospital Cost Report Public Use files and wage index files. The study population comprised New York state residents who underwent an isolated CABG procedure in a New York State hospital and were discharged in 2003. The outcome measure was inpatient costs. Independent variables included patient (demographic and clinical) and hospital characteristics.
The total number of cases was 12,016. Findings revealed that selected demographic characteristics, including older age, female gender, and being black, were associated with higher costs. Several clinical characteristics were found to affect CABG discharge costs such as lower ejection fraction, the duration between CABG admission and the occurrence of myocardial infarction, number of diseased vessels, previous open heart operations, and a number of comorbidities. Furthermore, larger hospitals were associated with higher CABG discharge costs, while costs significantly decreased with higher CABG volume.
Hospitals should explore ways to address patient (patient management) and hospital (case volume), when possible, associated with higher CABG discharge costs in its efforts to contain costs.
本研究旨在探讨术前风险因素及医院特征对冠状动脉搭桥术（CABG）住院费用的影响。
对医院心脏项目的大量投资并未伴随着对相关手术成本驱动因素进行类似的探索。
数据来源包括：（a）纽约州心脏手术报告系统；（b）纽约州全州规划与研究合作系统数据集；（c）美国医院协会数据集；以及（d）医疗保险医院成本报告公开使用文件和工资指数文件。研究人群包括2003年在纽约州医院接受单纯CABG手术并出院的纽约州居民。结局指标为住院费用。自变量包括患者（人口统计学和临床特征）及医院特征。
病例总数为12,016例。研究结果显示，选定的人口统计学特征，包括年龄较大、女性及黑人，与较高费用相关。发现若干临床特征会影响CABG出院费用，如射血分数较低、CABG入院至心肌梗死发生的时长、病变血管数量、既往心脏直视手术史以及多种合并症。此外，规模较大的医院与较高的CABG出院费用相关，而费用随CABG手术量增加显著降低。
医院在努力控制成本时，应探索应对与较高CABG出院费用相关的患者（患者管理）及医院（手术量）因素的方法。
