Cost containment via expense rationalization in open-heart surgery

Hospital costs and the fees of the surgeon, assistant, anesthesiologist, and cardiologist were reviewed in a community hospital doing 425 cardiac operations in the year 1977. Each item of the bill was analyzed and discussed with each department of the hospital. Changes made in the routine saved approximately $1000 per patient--16% for patients having mitral valves replacement (MVR), 15% for those having aortic valve replacement (AVR), 21% for those having saphenous vein bypass grafts (SVBG), and 23% for pediatric cases. The areas most likely to yield economic reductions without alteration of the quality of care are operating room, patient room, respiratory therapy, and pharmacy. Making the nurses, scrub technicians, surgical assistants, residents, and staff surgeons aware of the cost of each item and periodically discussing the alternatives could yield surprisingly large savings.

The cost of coronary bypass procedures

We reviewed the financial records of 200 succesive patients who had coronary artery bypass surgery in the first three months of 1976. The average hospital bill was $7,690 and the average length of stay was 18 days. The highest bill was $28,329 (79 days) and the lowest was $6,126 (11 days). The average total physician charge to the patient was $3,240. The total average hospital and physician cost was $10,930.

Benefits from aortocoronary bypass graft

The first aortocoronary bypass graft (ACBG) for coronary heart disease (CHD) was performed in 1964. From 1967 to the summer of 1977, between 250,000 and 300,000 such procedures were performed in this country. With such extensive experience, the patient might expect that most questions regarding the effectiveness of the procedure in the treatment of CHD would have been answered. Unfortunately, this is not the case. After a decade of experience, all that is truly known about the procedure is that for most patients, it does improve the quality of life and, if present practices continue, will add greatly to the cost of medical care in this country. It appears that there is still a need for more randomized, controlled studies.

Influence of aortocoronary bypass surgery on employment

Aortocoronary bypass operations are expensive. Economic benefit might be derived if such operations influenced the ability of persons with symptomatic coronary artery disease to be employed. Follow-up data were obtained for 329 survivors of bypass operations 2 to 60 months (mean, 22.9 months) postoperatively; 178 had been working prior to the operation and 213 were working at the time of follow-up, for a net gain of 35 employed patients. Therefore, bypass surgery does lead to a small but significant increase in the proportion of angina patients who are employed.

Is coronary artery surgery so expensive?

Severe angina may lead to complete invalidism, with reliance on social security payments and accumulated savings. The average cost of this situation to the patient is $4-6000 pa and to the State $3-4000 pa. Reputedly expensive cardiac operations are cheaper, at under $2000, than unoperated invalidism, and thus rapidly repay their cost in addition to their non-financial attributes.