Longo K M, Cowen M E, Flaum M A, Valsania P, Schork M A, Wagner L A, Prager R L
St. Joseph Mercy Hospital and the University of Michigan School of Public Health, Ann Arbor, USA.
Ann Thorac Surg. 1998 Sep;66(3):740-5; discussion 746. doi: 10.1016/s0003-4975(98)00664-x.
Identification of preoperative factors that contribute to the cost of coronary artery bypass grafting could aid in predicting the procedure's expense. In this study, 30 sociodemographic and clinical preoperative factors were examined with "survival analysis" techniques to determine characteristics related to total hospital cost.
Characteristics of all patients age 65 or older undergoing isolated coronary artery bypass grafting from July 1993 to April 1995 (n = 757) were recorded. Software was developed within the hospital's Transitions Systems, Inc, database to calculate the outcome variable of total cost. Nonparametric methods were used for the univariate analysis of the data, and the Cox proportional hazards model was used for the multivariable analysis, censoring 25 patients who died in the hospital.
Median hospital cost from the day of the operation until discharge was $15,198. Median length of stay after the operation was 6 days. Multivariable analysis revealed that age, preoperative renal failure, history of cerebrovascular accident, low ejection fraction, and surgical urgency were independent predictors of total cost.
This study, using an accurate representation of true hospital cost and a modeling technique that accounts for the confounding effect of in-hospital death on cost, provides a template for analysis of cost in other patient groups.
识别导致冠状动脉搭桥手术费用的术前因素有助于预测该手术的花费。在本研究中，采用“生存分析”技术对30个社会人口统计学和临床术前因素进行了检查，以确定与总住院费用相关的特征。
记录了1993年7月至1995年4月期间接受单纯冠状动脉搭桥手术的所有65岁及以上患者（n = 757）的特征。在医院的转换系统公司数据库中开发了软件，以计算总费用这一结果变量。数据的单变量分析采用非参数方法，多变量分析采用Cox比例风险模型，对25例在医院死亡的患者进行删失处理。
从手术日至出院的住院费用中位数为15,198美元。术后中位住院时间为6天。多变量分析显示，年龄、术前肾衰竭、脑血管意外病史、低射血分数和手术紧迫性是总费用的独立预测因素。
本研究使用了真实住院费用的准确表示方法以及一种考虑了住院死亡对费用的混杂影响的建模技术，为分析其他患者群体的费用提供了一个模板。
