Dataset Information

Healthcare utilization and costs of cardiopulmonary complications following cardiac surgery in the United States.

ABSTRACT:

Purpose

This study examined postoperative heart failure (HF) and respiratory failure (RF) complications and related healthcare utilization for one year following cardiac surgery.

Methods

This study identified adult patients undergoing isolated coronary artery bypass graft (CABG) and/or valve procedures from the Cerner Health Facts® database. It included patients experiencing postoperative HF or RF complications. We quantified healthcare utilization using the frequency of inpatient admissions, emergency department (ED) visits with or without hospital admission, and outpatient visits. We then determined direct hospital costs from the determined healthcare utilization. We analyzed trends over time for both HF and RF and evaluated the association between surgery type and HF complication.

Results

Of 10,298 patients with HF complications, 1,714 patients (16.6%) developed persistent HF; of the 10,385 RF patients, 175 (1.7%) developed persistent RF. Healthcare utilization for those with persistent complications over the one-year period following index hospital discharge comprised an average number of the following visit types: Inpatient (1.49 HF; 1.55 RF), Outpatient (2.02, 0.51), ED without hospital admission (0.33, 0.13), ED + Inpatient (0.08, 0.06). Per patient annual costs related to persistent complications of HF and RF were $20,857 and $30,745, respectively. There was a significant association between cardiac surgical type and the incidence of HF, with risk for isolated valve procedures (adjusted OR 2.60; 95% CI: 2.35-2.88) and CABG + valve procedures (adjusted OR 2.38; 95% CI: 2.17-2.61) exceeding risk for isolated CABG procedures.

Conclusions

This study demonstrates that HF and RF complication rates post cardiac surgery are substantial, and complication-related healthcare utilization over the first year following surgery results in significant incremental costs. Given the need for both payers and providers to focus on healthcare cost reduction, this study fills an important gap in quantifying the mid-term economic impact of postoperative cardiac surgical complications.

SUBMITTER: Stevens M

PROVIDER: S-EPMC6922411 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Healthcare utilization and costs of cardiopulmonary complications following cardiac surgery in the United States.

Stevens Mitali M Shenoy Apeksha V AV Munson Sibyl H SH Yapici Halit O HO Gricar Boye L A BLA Zhang Xuan X Shaw Andrew D AD

PloS one 20191219 12

<h4>Purpose</h4>This study examined postoperative heart failure (HF) and respiratory failure (RF) complications and related healthcare utilization for one year following cardiac surgery.<h4>Methods</h4>This study identified adult patients undergoing isolated coronary artery bypass graft (CABG) and/or valve procedures from the Cerner Health Facts® database. It included patients experiencing postoperative HF or RF complications. We quantified healthcare utilization using the frequency of inpatient ...[more]

PMID: 31856265

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Project description:STUDY DESIGN:A retrospective cohort study. OBJECTIVE:The aim of this study was to examine variation in spine surgery utilization between the province of Ontario and state of New York among all patients and pre-specified patient subgroups. SUMMARY OF BACKGROUND DATA:Spine surgery is common and costly. Within-country variation in utilization is well studied, but there has been little exploration of variation in spine surgery utilization between countries. METHODS:We used population-level administrative data from Ontario (years 2011-2015) and New York (2011-2014) to identify all adults who underwent inpatient spinal decompression or fusion surgery using relevant procedure codes. Patients were stratified according to age and surgical urgency (elective vs. emergent). We calculated standardized utilization rates (procedures per-10,000 population per year) for each jurisdiction. We compared Ontario and New York with respect to patient demographics and the percentage of hospitals performing spine surgery. We compared utilization rates of spinal decompression and fusion surgery in Ontario and New York among all patients and after stratifying by surgical urgency and patient age. RESULTS:Patients in Ontario were older than patients in New York for both decompression (mean age 58.8 vs. 51.3 years; P?<?0.001) and fusion (58.1 vs. 54.9; P?<?0.001). A smaller percentage of hospitals in Ontario than New York performed decompression (26.1% vs. 54.9%; P?<?0.001) or fusion (15.2% vs. 56.7%; P?<?0.001). Overall, utilization of spine surgery (decompression plus fusion) in Ontario was 6.6 procedures per-10,000 population per-year and in New York was 16.5 per-10,000 per-year (P?<?0.001). Ontario-New York differences in utilization were smaller for emergent cases (2.0 per 10,000 in Ontario vs. 2.5 in New York; P?<?0.001), but larger for elective cases (4.6 vs. 13.9; P?<?0.001). The lower utilization in Ontario was particularly large among younger patients (age <60 years). CONCLUSION:We found significantly lower utilization of spine surgery in Ontario than in New York. These differences should inform policy reforms in both jurisdictions. LEVEL OF EVIDENCE:3.

Dataset Information

Healthcare utilization and costs of cardiopulmonary complications following cardiac surgery in the United States.

Purpose

Methods

Results

Conclusions

Publications

Healthcare utilization and costs of cardiopulmonary complications following cardiac surgery in the United States.

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