Resource utilization in coronary artery bypass operation: does surgical risk predict cost? Christopher J Riordan, MD, Milo Engoren, MD, Anoar Zacharias,

Slides:

Advertisements

Similar presentations

Total arterial revascularization of triple vessel coronary disease based on combined internal thoracic and radial artery grafts Robert H. Habib, PhD,

Advertisements

Results of Coronary Artery Endarterectomy and Coronary Artery Bypass Grafting for Diffuse Coronary Artery Disease Srikrishna Sirivella, MD, Isaac Gielchinsky,

Factors Influencing Hospital Length of Stay After Robotic Totally Endoscopic Coronary Artery Bypass Grafting Jeffrey D. Lee, MD, Nikolaos Bonaros, MD,

Elevated Hemoglobin A1c Is Associated With Lower Socioeconomic Position and Increased Postoperative Infections and Longer Hospital Stay After Cardiac.

Is Hospital Procedure Volume a Reliable Marker of Quality for Coronary Artery Bypass Surgery? A Comparison of Risk and Propensity Adjusted Operative and.

Bilateral Internal Mammary Artery Use for Coronary Artery Bypass Grafting Remains Underutilized: A Propensity-Matched Multi-Institution Analysis Damien.

Todd C. Crawford, MD, J. Trent Magruder, MD, Joshua C

Manuel Caceres, MD, Darryl S. Weiman, MD, JD

Leena Khaitan, MD, Francis P Sutter, Scott M Goldman, MD

Elevated Hemoglobin A1c Is Associated With Lower Socioeconomic Position and Increased Postoperative Infections and Longer Hospital Stay After Cardiac.

Jeevan Nagendran, MD, Colleen M. Norris, PhD, Michelle M

Damien J. LaPar, MD, MSc, Carlos M. Mery, MD, MPH, Benjamin D

Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon’s National Cardiac Database

Predicting In-Hospital Mortality After Redo Cardiac Operations: Development of a Preoperative Scorecard Sebastian Launcelott, BA, BComm, Maral Ouzounian,

Existing General Population Models Inaccurately Predict Lung Cancer Risk in Patients Referred for Surgical Evaluation James M. Isbell, MD, MSCI, Stephen.

James Edgerton, MD, Giovanni Filardo, PhD, MPH, William H

Comparison of EuroSCORE II, Original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients Niv Ad, MD, Sari D. Holmes,

Comparing Long-Term Survival Between Patients Undergoing Off-Pump and On-Pump Coronary Artery Bypass Graft Operations Giovanni Filardo, PhD, MPH, Paul.

The Impact of Peripheral Vascular Disease on Long-Term Survival After Coronary Artery Bypass Graft Surgery Danny Chu, MD, Faisal G. Bakaeen, MD, Xing.

Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: Development of a Predictive Risk Algorithm Mitchell J. Magee, MD, Morley A. Herbert,

Frederick L Grover, MD The Annals of Thoracic Surgery

Sequential Radial Artery Grafts for Multivessel Coronary Artery Bypass Graft Surgery: 10-Year Survival and Angiography Results Thomas A. Schwann, MD,

Robert E. Freundlich, MD, MS, Michael D. Maile, MD, MS, Mark M

What is the marginal cost for marginal risk in cardiac surgery?

Randal S. Blank, MD, PhD, Christoph Hucklenbruch, MD, Kelly K

Habib Jabagi, MD, MS, Diem T

Simple Index to Predict Likelihood of Skilled Nursing Facility Admission After Coronary Artery Bypass Grafting Among Older Patients David C. Chang, PhD,

Central venous catheter use in low-risk coronary artery bypass grafting Robert D Stewart, MD, Triffin Psyhojos, MD, Stephen J Lahey, MD, Sidney Levitsky,

Performing Coronary Artery Bypass Grafting Off-Pump May Compromise Long-Term Survival in a Veteran Population Faisal G. Bakaeen, MD, Danny Chu, MD, Rosemary.

Established Preoperative Risk Factors Do Not Predict Long-Term Survival in Isolated Coronary Artery Bypass Grafting Patients Giovanni Filardo, PhD, MPH,

Factors Influencing Hospital Length of Stay After Robotic Totally Endoscopic Coronary Artery Bypass Grafting Jeffrey D. Lee, MD, Nikolaos Bonaros, MD,

Milo Engoren, MD, Thomas A. Schwann, MD, Robert H. Habib, PhD, Sean N

Mariano E. Brizzio, MD, Alex Zapolanski, MD, Richard E

Coronary Artery Bypass Graft Surgery Using the Radial Artery, Right Internal Thoracic Artery, or Saphenous Vein as the Second Conduit Robert F. Tranbaugh,

Use of Amiodarone After Major Lung Resection

Effects of Blood Transfusion on Cause-Specific Late Mortality After Coronary Artery Bypass Grafting—Less Is More Thomas A. Schwann, MD, Joseph R. Habib,

Development and Validation of a Score to Predict the Risk of Readmission After Adult Cardiac Operations Arman Kilic, MD, Jonathan T. Magruder, MD, Joshua.

Effect of blood transfusion on long-term survival after cardiac operation Milo C Engoren, MD, Robert H Habib, PhD, Anoar Zacharias, MD, Thomas A Schwann,

Terry Shih, MD, Justin B. Dimick, MD, MPH

Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off- pump coronary bypass patients John D Puskas, MD, Vinod H Thourani,

Robert H. Habib, PhD, Thomas A. Schwann, MD, Milo Engoren, MD

Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery Anoar Zacharias, MD, Thomas A. Schwann,

W. Brent Keeling, MD, Jose Binongo, PhD, Michael E

Off-Pump Coronary Artery Bypass Disproportionately Benefits High-Risk Patients John D. Puskas, MD, Vinod H. Thourani, MD, Patrick Kilgo, MS, William Cooper,

Limitations of Hospital Volume as a Measure of Quality of Care for Coronary Artery Bypass Graft Surgery Karl F. Welke, MD, Mitchell J. Barnett, PharmD,

Impact of Functional Status on Survival After Coronary Artery Bypass Grafting in a Veteran Population Roberto Cervera, MD, Faisal G. Bakaeen, MD, Lorraine.

Survival After Isolated Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction Waleed A. Ahmed, MD, Phillip J. Tully, BHSc(Hons),

First Report on 30-day and Operative Mortality in Risk Model of Isolated Coronary Artery Bypass Grafting in Japan Noboru Motomura, MD, PhD, Hiroaki Miyata,

Trends in Patient Characteristics and Outcomes of Coronary Artery Bypass Grafting in the 2000 to 2012 Medicare Population Christian McNeely, MD, Stephen.

Does Preoperative Hemoglobin Independently Predict Short-Term Outcomes After Coronary Artery Bypass Graft Surgery? Melanie L. Bell, PhD, Gary K. Grunwald,

Interinstitutional Comparison of Risk-Adjusted Mortality and Length of Stay in Congenital Heart Surgery William M. DeCampli, MD, PhD, Redmond P. Burke,

Measuring for improvement: from Toyota to thoracic surgery

Effect of Coronary Artery Disease Extent on Contemporary Outcomes of Combined Aortic Valve Replacement and Coronary Artery Bypass Graft Surgery Zhongmin.

Improved Long-Term Survival for Diabetic Patients With Surgical Versus Interventional Revascularization Paul Kurlansky, MD, Morley Herbert, PhD, Syma.

Niv Ad, MD, Sari D. Holmes, PhD, Deborah J

Incidence and Predictors of Postoperative Deep Vein Thrombosis in Cardiac Surgery in the Era of Aggressive Thromboprophylaxis Thomas A. Schwann, MD,

Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? Robert H Habib, PhD, Anoar Zacharias,

A Risk Score to Predict Acute Renal Failure in Adult Patients After Lung Transplantation Joshua C. Grimm, MD, Cecillia Lui, BSE, Arman Kilic, MD, Vicente.

Predicting Early Coronary Artery Bypass Graft Failure by Intraoperative Transit Time Flow Measurement Yoshiyuki Tokuda, MD, Min-Ho Song, MD, PhD, Yuichi.

Increased Rehospitalization Rate After Coronary Bypass Operation for Acute Coronary Syndrome: A Prospective Study in 200 Patients Staffan Bjessmo, MD,

Gary L Grunkemeier, PhD, Ruyun Jin, MD The Annals of Thoracic Surgery

Dumbor L. Ngaage, MD, FRCS (C-Th), Michael E. Cowen, FRCS

Hisato Takagi, MD, PhD, Masafumi Matsui, MD, Takuya Umemoto, MD, PhD

Utilization and Outcomes of Unprotected Left Main Coronary Artery Stenting and Coronary Artery Bypass Graft Surgery Chuntao Wu, MD, PhD, Edward L. Hannan,

Sara K. Pasquali, MD, MHS, Xia He, MS, Marshall L

Left Ventricular End-Diastolic Pressure Predicts Survival in Coronary Artery Bypass Graft Surgery Patients Jeevan Nagendran, MD, PhD, Colleen M. Norris,

On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy Jan Bucerius, MD,

Mary E. Plomondon, PhD, Adrianne W. Casebeer, PhD, Lynn M

Kim I. de la Cruz, MD, Faisal G

Vinay Badhwar, MD, J. Scott Rankin, MD, Jeffrey P. Jacobs, MD, David M

Presentation transcript:

Resource utilization in coronary artery bypass operation: does surgical risk predict cost? Christopher J Riordan, MD, Milo Engoren, MD, Anoar Zacharias, MD, Thomas A Schwann, MD, Gary L Parenteau, MD, Samuel J Durham, MD, Robert H Habib, PhD The Annals of Thoracic Surgery Volume 69, Issue 4, Pages 1092-1097 (April 2000) DOI: 10.1016/S0003-4975(99)01562-3

Fig 1 Histogram of the frequency distribution of cost of coronary artery bypass grafting referenced to the median cost. Bell shaped curve indicates a near normal distribution of cost. Note, outlier patients (21 of 627) all with cost greater than 3 times median cost are lumped together. The Annals of Thoracic Surgery 2000 69, 1092-1097DOI: (10.1016/S0003-4975(99)01562-3)

Fig 2 (A) The relationship between cost and length of hospital stay (LOS) from 607 coronary artery bypass graft patients (excluding 21 outliers), indicating a linear correlation corresponding to R2 = 0.48. (B) Bland-Altman plot of the cost prediction error [error (%) = 100∗ (actual cost − estimated cost)/estimated cost] for each patient based on cost-LOS model depicted by regression line in panel A. These results indicate that LOS is an unbiased estimator of coronary artery bypass grafting cost (bias = 0.4%), but it can be quite inaccurate in individual patients as depicted by wide limits (∼50%) of agreement defined by bias ± 2S of the error. The Annals of Thoracic Surgery 2000 69, 1092-1097DOI: (10.1016/S0003-4975(99)01562-3)

Fig 3 (A) The relationship between cost and The Society of Thoracic Surgeons Risk [STS risk (%)] from 607 coronary artery bypass graft patients (excluding 21 outliers) along with the linear regression results indicating a poor correlation (R2 = 0.12). (B) Bland-Altman plot of the cost prediction error [error (%) = 100∗ (actual cost − estimated cost)/estimated cost] for each patient based on cost-STS risk model depicted by regression line in panel A. These results indicate that STS risk is an unbiased estimator of coronary artery bypass grafting cost (bias = 0.4%), but it can be quite inaccurate in individual patients as depicted by wide limits (∼63%) of agreement defined by bias ± 2S of the error. The Annals of Thoracic Surgery 2000 69, 1092-1097DOI: (10.1016/S0003-4975(99)01562-3)

Fig 4 (A) The relationship between length of stay (LOS) and The Society of Thoracic Surgeons Risk [STS risk (%)] from 607 coronary artery bypass graft patients (excluding 21 outliers) along with the linear regression results indicating a poor correlation (R2 = 0.09). (B) Bland-Altman plot of the LOS prediction error [error (%) = 100∗ (actual cost − estimated cost)/estimated cost] for each patient based on LOS-STS risk model depicted by regression line in panel A. These results indicate that STS risk is an unbiased estimator of LOS following coronary artery bypass grafting (bias = 0.4%), but it can be highly inaccurate in individual patients as depicted by the wide limits (∼95%) of agreement defined by bias ± 2S of the error. The Annals of Thoracic Surgery 2000 69, 1092-1097DOI: (10.1016/S0003-4975(99)01562-3)

Fig 5 Prediction of coronary artery bypass graft cost from length of stay (LOS) (A) and STS risk (B), as well as LOS from STS risk (C) when patients were grouped into 6 patient cohorts, based on comparable risk as described in Table 1. Results indicate that cost-LOS, cost-STS risk and LOS-STS risk relationships, in sufficiently large patient cohorts, are all highly linear. These linear relationships provide simple models for predicting the impact of changes in clinical risk for the general coronary artery bypass graft population on expected costs. The Annals of Thoracic Surgery 2000 69, 1092-1097DOI: (10.1016/S0003-4975(99)01562-3)