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


Autoři: Mitali Stevens aff001;  Apeksha V. Shenoy aff002;  Sibyl H. Munson aff002;  Halit O. Yapici aff002;  Boye L. A. Gricar aff002;  Xuan Zhang aff002;  Andrew D. Shaw aff003
Působiště autorů: Global Health Economics & Reimbursement, Edwards Lifesciences, Irvine, California, United States of America aff001;  Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, Massachusetts, United States of America aff002;  Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226750

Souhrn

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.

Klíčová slova:

Cardiac surgery – Coronary artery bypass grafting – Critical care and emergency medicine – Heart failure – Hospitals – Inpatients – Respiratory failure – Surgical and invasive medical procedures


Zdroje

1. The Society of Thoracic Surgeons. Executive Summary, Adult Cardiac Surgery Database. 2018.

2. D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. The Annals of Thoracic Surgery. 2018;105(1):15–23. doi: 10.1016/j.athoracsur.2017.10.035 29233331

3. Young RW. Prevention of lung injury in cardiac surgery: a review. The journal of extra-corporeal technology. 2014;46(2):130–41. 25208430.

4. Watson TA, Fleisher LA. Acute Heart Failure in the Postoperative Period. In: Mebazaa A, Gheorghiade M, Zannad FM, Parrillo JE, editors. Acute Heart Failure. London: Springer London; 2008. p. 323–32.

5. Lee R, Li S, Rankin JS, O'Brien SM, Gammie JS, Peterson ED, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011;91(3):677–84; discussion p 84. doi: 10.1016/j.athoracsur.2010.11.009 21352979.

6. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest. 2008;133(3):713–21. doi: 10.1378/chest.07-1028 18263692.

7. Rahmanian PB, Kroner A, Langebartels G, Ozel O, Wippermann J, Wahlers T. Impact of major non-cardiac complications on outcome following cardiac surgery procedures: logistic regression analysis in a very recent patient cohort. Interact Cardiovasc Thorac Surg. 2013;17(2):319–26; discussion 26–7. doi: 10.1093/icvts/ivt149 23667066; PubMed Central PMCID: PMC3715168.

8. Mehaffey JH, Hawkins RB, Byler M, Charles EJ, Fonner C, Kron I, et al. Cost of individual complications following coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery. 2018;155(3):875–82.e1. doi: 10.1016/j.jtcvs.2017.08.144 29248284

9. Vanky FB, Hakanson E, Svedjeholm R. Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgery. Ann Thorac Surg. 2007;83(6):2036–43. doi: 10.1016/j.athoracsur.2007.01.031 17532392.

10. Qiu Z, Chen X, Xu M, Jiang Y, Xiao L, Liu L, et al. Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction? J Cardiothorac Surg. 2010;5:107. doi: 10.1186/1749-8090-5-107 21059216; PubMed Central PMCID: PMC2987923.

11. HCUP Databases, Healthcare Cost and Utilization Project (HCUP) [Internet]. 2018. Available from: www.hcup-us.ahrq.gov/databases.jsp.

12. Kilgore M, Patel HK, Kielhorn A, Maya JF, Sharma P. Economic burden of hospitalizations of Medicare beneficiaries with heart failure. Risk management and healthcare policy. 2017;10:63. doi: 10.2147/RMHP.S130341 28546776

13. Nicholson G, Gandra SR, Halbert RJ, Richhariya A, Nordyke RJ. Patient-level costs of major cardiovascular conditions: a review of the international literature. ClinicoEconomics and outcomes research: CEOR. 2016;8:495.

14. Pfuntner A, Wier L, Steiner C. Costs for hospital stays in the United States, 2011: Statistical Brief# 168. 2013.

15. Pfuntner A, Wier LM, Steiner C. Costs for Hospital Stays in the United States, 2010: Statistical Brief #146. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013.

16. Speir AM, Kasirajan V, Barnett SD, Fonner E Jr. Additive costs of postoperative complications for isolated coronary artery bypass grafting patients in Virginia. The Annals of thoracic surgery. 2009;88(1):40–6. doi: 10.1016/j.athoracsur.2009.03.076 19559186

17. Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Steingrub JS, Lagu T, et al. Epidemiology and outcomes of acute respiratory failure in the U nited States, 2001 to 2009: A national survey. Journal of hospital medicine. 2013;8(2):76–82. doi: 10.1002/jhm.2004 23335231

18. Yoon J, Fonarow GC, Groeneveld PW, Teerlink JR, Whooley MA, Sahay A, et al. Patient and facility variation in costs of VA heart failure patients. JACC: Heart Failure. 2016;4(7):551–8. doi: 10.1016/j.jchf.2016.01.003 26970829

19. Voigt J, John MS, Taylor A, Krucoff M, Reynolds MR, Michael Gibson C. A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States. Clinical cardiology. 2014;37(5):312–21. doi: 10.1002/clc.22260 24945038

20. Gray A, Goodacre S, Newby D, Masson M, Sampson F, Dixon S, et al. A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the 3CPO trial. Health technology assessment (Winchester, England). 2009;13(33):1–106.

21. Vitacca M, Bianchi L, Guerra A, Fracchia C, Spanevello A, Balbi B, et al. Tele-assistance in chronic respiratory failure patients: a randomised clinical trial. European Respiratory Journal. 2009;33(2):411–8. doi: 10.1183/09031936.00005608 18799512

22. Hazenberg A, Kerstjens HA, Prins SC, Vermeulen KM, Wijkstra PJ. Initiation of home mechanical ventilation at home: a randomised controlled trial of efficacy, feasibility and costs. Respiratory medicine. 2014;108(9):1387–95. Epub 2014/08/02. doi: 10.1016/j.rmed.2014.07.008 25081652.

23. Pallero M, Puy C, Guell R, Pontes C, Marti S, Torres F, et al. Ambulatory adaptation to noninvasive ventilation in restrictive pulmonary disease: a randomized trial with cost assessment. Respiratory medicine. 2014;108(7):1014–22. Epub 2014/05/20. doi: 10.1016/j.rmed.2014.04.016 24837977.

24. Clini EM, Magni G, Crisafulli E, Viaggi S, Ambrosino N. Home non-invasive mechanical ventilation and long-term oxygen therapy in stable hypercapnic chronic obstructive pulmonary disease patients: comparison of costs. Respiration; international review of thoracic diseases. 2009;77(1):44–50. Epub 2008/04/18. doi: 10.1159/000127410 18417954.

25. Wilson L, Devine EB, So K. Direct medical costs of chronic obstructive pulmonary disease: chronic bronchitis and emphysema. Respiratory medicine. 2000;94(3):204–13. doi: 10.1053/rmed.1999.0720 PubMed 10783930.

26. Physician Fee Schedule [Internet]. 2018. Available from: https://www.cms.gov/apps/physician-fee-schedule/.

27. CPI Inflation Calculator [Internet]. Available from: https://www.bls.gov/data/inflation_calculator.htm.

28. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51. doi: 10.1016/0895-4356(94)90129-5 7722560.

29. Shi M, Huang J, Pang L, Wang Y. Preoperative insertion of an intra-aortic balloon pump improved the prognosis of high-risk patients undergoing off-pump coronary artery bypass grafting. J Int Med Res. 2011;39(4):1163–8. doi: 10.1177/147323001103900404 21986118.

30. Bailey ML, Richter SM, Mullany DV, Tesar PJ, Fraser JF. Risk factors and survival in patients with respiratory failure after cardiac operations. Ann Thorac Surg. 2011;92(5):1573–9. doi: 10.1016/j.athoracsur.2011.04.019 21855851.

31. Sabate S, Mazo V, Canet J. Predicting postoperative pulmonary complications: implications for outcomes and costs. Curr Opin Anaesthesiol. 2014;27(2):201–9. doi: 10.1097/ACO.0000000000000045 24419159.


Článek vyšel v časopise

PLOS One


2019 Číslo 12