Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
Virginia Cardiac Services Quality Initiative, Virginia Beach, Va.
J Thorac Cardiovasc Surg. 2018 Mar;155(3):875-882.e1. doi: 10.1016/j.jtcvs.2017.08.144. Epub 2017 Dec 14.
The financial implications of postoperative complications in cardiac surgery remain poorly understood. The purpose of this study was to define the cost of surgery without complications and demonstrate the incremental cost of each complication.
All patients undergoing isolated coronary artery bypass grafting (CABG) were evaluated (2006-2015) from a statewide Society of Thoracic Surgeons database collaborative (N = 36,588). Patients were stratified by presence of postoperative complications, including major morbidities as defined by the Society of Thoracic Surgeons (ie, prolonged ventilation, renal failure, reoperation, stroke, and deep sternal wound infection). Hierarchical modeling was used to identify the independent inflation-adjusted cost of each complication while controlling for hospital variation and time.
The median age was 64 years, 74.3% were men, and average predicted risk of mortality was 1.9%. A total of 24,738 (67.7%) patients experienced no complications at an average cost of $36,580. Each complication independently increases the cost of care and resulted in an exponential increase in cost. After accounting for incidence and incremental costs, institutions in our collaborative have spent an estimated $59.1 million on prolonged ventilation, $8.3 million on renal failure, $7.6 million on reoperation, $3.3 million on stroke, and $256,000 on deep sternal wound infections over the past 10 years.
The average cost of CABG without complication was $36,580. Each additional major complication resulted in an exponential increase in cost. Over the past 10 years, the total cost of complications after isolated CABG was $78.6 million, emphasizing the importance of quality improvement projects to contain costs.
心脏手术后并发症的经济影响仍未得到充分理解。本研究旨在确定无并发症手术的成本，并展示每种并发症的增量成本。
从全州胸外科医师协会数据库合作项目（2006-2015 年）中评估了所有接受单纯冠状动脉旁路移植术（CABG）的患者（N=36588）。根据术后并发症的存在情况对患者进行分层，包括胸外科医师协会定义的主要并发症（即长时间通气、肾衰竭、再次手术、中风和深部胸骨伤口感染）。使用分层模型确定每个并发症的独立通胀调整后的成本，同时控制医院差异和时间。
中位年龄为 64 岁，74.3%为男性，平均预测死亡率为 1.9%。共有 24738 例（67.7%）患者无并发症，平均费用为 36580 美元。每种并发症都会独立增加医疗成本，并导致成本呈指数级增长。在考虑发病率和增量成本后，我们合作机构在过去 10 年中估计在长时间通气上花费了 5910 万美元，在肾衰竭上花费了 830 万美元，在再次手术上花费了 760 万美元，在中风上花费了 330 万美元，在深部胸骨伤口感染上花费了 25.6 万美元。
无并发症 CABG 的平均成本为 36580 美元。每增加一种主要并发症都会导致成本呈指数级增加。在过去 10 年中，单纯 CABG 后并发症的总成本为 7860 万美元，强调了质量改进项目对于控制成本的重要性。
