Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md; Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
J Thorac Cardiovasc Surg. 2023 Feb;165(2):764-772.e2. doi: 10.1016/j.jtcvs.2021.02.094. Epub 2021 Mar 9.
Coronary artery bypass grafting is associated with significant interhospital variability in charges. Drivers of hospital charge variability remain elusive. We identified modifiable factors associated with statewide interhospital variability in hospital charges for coronary artery bypass grafting.
Charge data were used as a surrogate for cost. Society of Thoracic Surgeons data from Maryland institutions and charge data from the Maryland Health Care Commission were linked to characterize interhospital charge variability for coronary artery bypass grafting. Multivariable linear regression was used to identify perioperative factors independently related to coronary artery bypass grafting charges. Of the factors independently associated with charges, we analyzed which factors varied between hospitals.
A total of 10,337 patients underwent isolated coronary artery bypass grafting at 9 Maryland hospitals from 2012 to 2016, of whom 7532 patients were available for analyses. Mean normalized charges for isolated coronary artery bypass grafting varied significantly among hospitals, ranging from $30,000 to $57,000 (P < .001). Longer preoperative length of stay, operating room time, and major postoperative morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection were associated with greater hospital charges. Incidence of major postoperative events, except stroke and deep sternal wound infection, was variable between hospitals. In a univariate linear regression model, patient risk profile only accounted for approximately 10% of statistical variance in charges.
There is significant charge variability for coronary artery bypass grafting among hospitals within the same state. By targeting variation in preoperative length of stay, operating room time, postoperative renal failure, prolonged ventilation, and reoperation, cardiac surgery programs can realize cost savings while improving quality of care for this resource-intense patient population.
冠状动脉旁路移植术的费用在医院间存在显著差异。导致医院收费差异的因素仍不清楚。我们确定了与全州范围内冠状动脉旁路移植术医院收费差异相关的可改变因素。
收费数据被用作成本的替代指标。马里兰州各机构的胸外科协会数据和马里兰州医疗保健委员会的收费数据被关联起来，以描述冠状动脉旁路移植术的医院间收费差异。多变量线性回归用于确定与冠状动脉旁路移植术收费独立相关的围手术期因素。在与收费独立相关的因素中，我们分析了医院间差异的因素。
2012 年至 2016 年，9 家马里兰州医院共对 10337 例患者进行了单纯冠状动脉旁路移植术，其中 7532 例患者可进行分析。单纯冠状动脉旁路移植术的标准化收费在医院间差异显著，范围从 30000 美元到 57000 美元（P<.001）。术前住院时间、手术室时间以及包括中风、肾衰竭、长时间通气、再次手术和深部胸骨伤口感染在内的主要术后并发症的延长与更高的医院收费相关。除中风和深部胸骨伤口感染外，主要术后事件的发生率在医院间存在差异。在单变量线性回归模型中，患者风险状况仅占收费差异的约 10%。
在同一州内，医院之间的冠状动脉旁路移植术收费存在显著差异。通过针对术前住院时间、手术室时间、术后肾衰竭、长时间通气和再次手术的差异，心脏手术项目可以在提高对这一资源密集型患者群体的护理质量的同时实现成本节约。
