Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
Columbia University Medical Center and New York Presbyterian Hospital, New York, New York.
JACC Cardiovasc Interv. 2019 Feb 25;12(4):323-331. doi: 10.1016/j.jcin.2018.10.025. Epub 2019 Jan 30.
The aim of this study was to describe the costs of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and the association of complications during CTO PCI with costs and length of stay (LOS).
CTO PCI generally requires more procedural resources and carries higher risk for complications than PCI of non-CTO vessels. The costs of CTO PCI using the hybrid approach have not been described, and no studies have examined the impact of complications on in-hospital costs and LOS in this population.
Costs were calculated for 964 patients in the 12-center OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry using prospectively collected resource utilization and billing data. Multivariate models were developed to estimate the incremental costs and LOS associated with complications. Attributable costs and LOS were calculated by multiplying the independent cost of each event by its frequency in the population.
Mean costs for the index hospitalization were $17,048 ± 9,904; 14.5% of patients experienced at least 1 complication. Patients with complications had higher mean hospital costs (by $8,603) and LOS (by 1.5 days) than patients without complications. Seven complications were independently associated with increased costs and 6 with LOS; clinically significant perforation and myocardial infarction had the greatest attributable cost per patient. Overall, complications accounted for $911 per patient in hospital costs (5.3% of the total costs) and 0.2 days of additional LOS.
Complications have a significant impact on both LOS and in-hospital costs for patients undergoing CTO PCI. Methods to identify high-risk patients and develop strategies to prevent complications may reduce CTO PCI costs.
本研究旨在描述慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的成本，以及 CTO PCI 过程中发生并发症与成本和住院时间（LOS）的关系。
相较于非 CTO 血管 PCI，CTO PCI 通常需要更多的手术资源，并且发生并发症的风险更高。尚未对杂交方法进行 CTO PCI 的成本进行描述，也没有研究在该人群中考察并发症对住院内成本和 LOS 的影响。
OPEN-CTO（慢性完全闭塞杂交手术的结果、患者健康状况和效率）注册中心的 964 例患者的成本是通过前瞻性收集的资源利用和计费数据进行计算的。采用多变量模型估计并发症相关的增量成本和 LOS。通过将每个事件的独立成本乘以其在人群中的频率，计算归因成本和 LOS。
指数住院的平均成本为$17048 ± 9904；14.5%的患者至少发生了 1 种并发症。与无并发症患者相比，有并发症患者的平均住院费用（高$8603）和 LOS（多 1.5 天）更高。7 种并发症与成本增加相关，6 种与 LOS 相关；临床显著穿孔和心肌梗死的患者每位患者的归因成本最高。总体而言，并发症导致每位患者住院费用增加$911（占总费用的 5.3%），LOS 增加 0.2 天。
并发症对接受 CTO PCI 治疗的患者的 LOS 和住院内成本都有重大影响。确定高风险患者并制定预防并发症策略的方法可能会降低 CTO PCI 的成本。
