Determinants of hospital charges for coronary artery bypass surgery: The economic consequences of postoperative complications

• Published in: The American journal of cardiology Vol. 65; no. 5; pp. 309 - 313
• Main Authors: Taylor, George J., Mikell, Frank L., Moses, H.Weston, Dove, James T., Katholi, Richard E., Malik, Shezad A., Markwell, Stephen J., Korsmeyer, Cynthia, Schneider, Joel A., Wellons, Harry A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.1990; Elsevier
• Subjects: Aged; Biological and medical sciences; Coronary Artery Bypass - economics; Cost-Benefit Analysis; Fees and Charges - statistics & numerical data; Female; Humans; Illinois; Male; Medical sciences; Middle Aged; Postoperative Complications - economics; Prospective Studies; Regression Analysis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgical Wound Infection - economics; Illinois; Human; Postoperative; Costs; Aortocoronary; Bypass; Surgery; Cardiovascular disease; Complication; Regression analysis; Public health
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(90)90293-A

This is a prospective study of 500 consecutive patients having coronary artery bypass surgery; mean hospital charge from time of surgery to discharge was $11,900 ± 12,700. Multiple regression analysis was performed using preoperative variables and postoperative complications. No preoperative clinical feature was a significant predictor of higher average charge. Sternal wound infection (p = 0.0001), respiratory failure (p = 0.0001) and left ventricular failure (p = 0.017) were associated with higher average hospital charge. The absence of any complication predicted a lower average charge, and postoperative death (4.4 ± 4.5 days after surgery) was also associated with lower average charge. A cost equation was developed: hospital charge equalled $11,217 + $41,559 for sternal wound infection, + $28,756 for respiratory failure, + $5,186 for left ventricular failure, − $1,798 for no complication and − $6,019 for death. Recognition of the influence of complications on charges suggests that low average charges can only be achieved by surgical programs with a low complication rate.