The following is a summary of the “Hospital variability in modifiable factors driving coronary artery bypass charges,” published in the February 2023 issue of Thoracic and Cardiovascular Surgery by Salenger, et al.
Coronary artery bypass grafting costs vary widely from one medical facility to the next. The factors that cause variation in hospital costs are still unknown. They found modifiable factors linked to the wide range of CABG hospital charges across the state. The cost was approximated using charge data. The variation in costs for coronary artery bypass grafting between hospitals was characterized by linking data from the Society of Thoracic Surgeons with costs reported to the Maryland Health Care Commission. Perioperative factors independently related to coronary artery bypass grafting costs were identified using multivariable linear regression. They examined which factors independently linked to hospital costs differed between facilities.
From 2012 to 2016, 10,337 patients in Maryland received an isolated coronary artery bypass graft at 9 different hospitals, with data from 7,532 of those patients being used for statistical purposes. There was a huge discrepancy in the average normalized costs of coronary artery bypass grafting performed at different hospitals, ranging from $30,000 to $57,000 (P<.001). Expenses ran higher when patients stayed in the hospital longer before surgery, during surgery, and afterward due to complications like stroke, kidney failure, prolonged ventilation, reoperation, and deep sternal wound infection.
The incidence of serious complications after surgery varied widely between institutions, except for stroke and deep sternal wound infection. Only about 10% of the statistical cost variation could be explained by the patient risk profile in a univariate linear regression model. Coronary artery bypass grafting costs vary widely between hospitals, even within the same state. Saving money while enhancing the quality of care for these patients who use many resources is possible through cardiac surgery programs that focus on reducing variation in the preoperative length of stay, operative time, postoperative renal failure, prolonged ventilation, and reoperation.