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Wei C, Paranjpe I, Sharma P, Milligan M, Lam M, Heidenreich PA, Kalwani N, Schulman K, Sandhu A. Assessment of Price Variation in Coronary Artery Bypass Surgery at US Hospitals. J Am Heart Assoc 2024; 13:e031982. [PMID: 38362880 PMCID: PMC11010067 DOI: 10.1161/jaha.123.031982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/08/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Little is known about hospital pricing for coronary artery bypass grafting (CABG). Using new price transparency data, we assessed variation in CABG prices across US hospitals and the association between higher prices and hospital characteristics, including quality of care. METHODS AND RESULTS Prices for diagnosis related group code 236 were obtained from the Turquoise database and linked by Medicare Facility ID to publicly available hospital characteristics. Univariate and multivariable analyses were performed to assess factors predictive of higher prices. Across 544 hospitals, median commercial and self-pay rates were 2.01 and 2.64 times the Medicare rate ($57 240 and $75 047, respectively, versus $28 398). Within hospitals, the 90th percentile insurer-negotiated price was 1.83 times the 10th percentile price. Across hospitals, the 90th percentile commercial rate was 2.91 times the 10th percentile hospital rate. Regional median hospital prices ranged from $35 624 in the East South Central to $84 080 in the Pacific. In univariate analysis, higher inpatient revenue, greater annual discharges, and major teaching status were significantly associated with higher prices. In multivariable analysis, major teaching and investor-owned status were associated with significantly higher prices (+$8653 and +$12 200, respectively). CABG prices were not related to death, readmissions, patient ratings, or overall Centers for Medicare and Medicaid Services hospital rating. CONCLUSIONS There is significant variation in CABG pricing, with certain characteristics associated with higher rates, including major teaching status and investor ownership. Notably, higher CABG prices were not associated with better-quality care, suggesting a need for further investigation into drivers of pricing variation and the implications for health care spending and access.
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Affiliation(s)
- Chen Wei
- Department of MedicineStanford University School of MedicineStanfordCA
| | - Ishan Paranjpe
- Department of MedicineStanford University School of MedicineStanfordCA
| | | | | | | | - Paul A. Heidenreich
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCA
- Palo Alto Veteran’s Affairs Healthcare SystemPalo AltoCA
| | - Neil Kalwani
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCA
- Palo Alto Veteran’s Affairs Healthcare SystemPalo AltoCA
| | - Kevin Schulman
- Department of MedicineStanford University School of MedicineStanfordCA
- Clinical Excellence Research CenterStanford UniversityStanfordCA
- Operations, Information and Technology, Graduate School of BusinessStanford UniversityStanfordCA
| | - Alexander Sandhu
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCA
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCA
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Wang HB, Zhang L, Zhang Z, Yuan S, Yan FX, Luo QP. Effect of intraoperative dexmedetomidine infusion on delirium in adult patients following cardiac valve surgery: a protocol of a randomized, double-blinded, and placebo-controlled study. Trials 2020; 21:645. [PMID: 32665034 PMCID: PMC7362632 DOI: 10.1186/s13063-020-04574-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023] Open
Abstract
Background Delirium is an acute status of brain dysfunction that commonly occurs in patients who have undergone cardiac surgery, and increases morbidity and mortality. It is associated with risk factors, such as older age, use of narcotics, cardiopulmonary bypass, and hypothermia. Dexmedetomidine infusion might exert a neuroprotective effect. However, the effect of perioperative administration of dexmedetomidine on the incidence of postoperative delirium (POD) in patients undergoing cardiac or non-cardiac surgery is yet controversial. The present study aimed to reveal the effect of intraoperative dexmedetomidine administration on the incidence of delirium in adult patients following cardiac surgery. Methods This single-center, randomized, double-blinded, and placebo-controlled trial consisted of 652 patients randomly divided into two groups: dexmedetomidine and placebo. 0.6 μg/kg dexmedetomidine will be infused 10 min after central vein catheterization, followed by a continuous infusion at a speed of 0.4 μg/kg/h until the end of surgery in the dexmedetomidine group, while normal saline will be administered at the same rate in the placebo group. The primary outcome is the incidence of POD during the first 7 days post-surgery. The secondary outcomes include duration of mechanical ventilation after surgery, duration of stay in the intensive care unit and the hospital after surgery, incidence of hypotension during or after dexmedetomidine infusion, acute kidney injury and sudden arrhythmia during the hospital stay postoperatively, and all-cause mortality in 30 and 90 days after surgery, respectively. Discussion This study was approved by the Ethics Committee of the Chinese Academy of Medical Sciences Fuwai Hospital on 6 March 2019 (2019-1180). The results will be disseminated at academic conferences and submitted to peer-reviewed publications. Either positive or negative results will provide guidance for clinical practice. Trial registration The Chinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR1900022583. Registered on 17 April 2019.
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Affiliation(s)
- Hong-Bai Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, No. 167 North Lishi Road, Xicheng District, Beijing, China
| | - Liang Zhang
- Department of Anesthesiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, No. 6, 7 Branch Road, Panxi, Jiangbei District, Chongqing, China
| | - Zhe Zhang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, No. 167 North Lishi Road, Xicheng District, Beijing, China
| | - Su Yuan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, No. 167 North Lishi Road, Xicheng District, Beijing, China.
| | - Fu-Xia Yan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, No. 167 North Lishi Road, Xicheng District, Beijing, China
| | - Qi-Peng Luo
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, No. 167 North Lishi Road, Xicheng District, Beijing, China
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Alqahtani F, Aljohani S, Amin AH, Al-Hijji M, Ali OO, Holmes DR, Alkhouli M. Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States. Mayo Clin Proc 2018; 93:607-617. [PMID: 29506780 DOI: 10.1016/j.mayocp.2017.11.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/28/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR). PATIENTS AND METHODS Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs). RESULTS Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001). CONCLUSIONS African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Sami Aljohani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Ali Hama Amin
- Division of Cardiology, West Virginia University, Morgantown, WV
| | | | - Oluseun O Ali
- Novant Health Heart & Vascular Institute, Charlotte, NC
| | | | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University, Morgantown, WV; Department of Cardiology, Mayo Clinic, Rochester, MN.
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Guduguntla V, Syrjamaki JD, Ellimoottil C, Miller DC, Prager RL, Norton EC, Theurer P, Likosky DS, Dupree JM. Drivers of Payment Variation in 90-Day Coronary Artery Bypass Grafting Episodes. JAMA Surg 2018; 153:14-19. [PMID: 28832865 PMCID: PMC5833620 DOI: 10.1001/jamasurg.2017.2881] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/02/2017] [Indexed: 11/14/2022]
Abstract
Importance Coronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into current CABG payments and their variation is important for understanding the potential effects of bundled payment models in cardiac care. Objective To examine CABG payment variation and its drivers. Design, Setting, and Participants This retrospective cohort study used Medicare and private payer claims to identify patients who underwent nonemergent CABG surgery from January 1, 2012, through October 31, 2015. Ninety-day price-standardized, risk-adjusted, total episode payments were calculated for each patient, and hospitals were divided into quartiles based on the mean total episode payments of their patients. Payments were then subdivided into 4 components (index hospitalization, professional, postacute care, and readmission payments) and compared across hospital quartiles. Seventy-six hospitals in Michigan representing a diverse set of geographies and practice environments were included. Main Outcomes and Measures Ninety-day CABG episode payments. Results A total of 5910 patients undergoing nonemergent CABG surgery were identified at 33 of the 76 hospitals; of these, 4344 (73.5%) were men and mean (SD) age was 68.0 (9.3) years. At the patient level, risk-adjusted, 90-day total episode payments for CABG varied from $11 723 to $356 850. At the hospital level, the highest payment quartile of hospitals had a mean total episode payment of $54 399 compared with $45 487 for the lowest payment quartile (16.4% difference, P < .001). The highest payment quartile hospitals compared with the lowest payment quartile hospitals had 14.6% higher index hospitalization payments ($34 992 vs $30 531, P < .001), 33.9% higher professional payments ($8060 vs $6021, P < .001), 29.6% higher postacute care payments ($7663 vs $5912, P < .001), and 35.1% higher readmission payments ($3576 vs $2646, P = .06). The drivers of this variation are diagnosis related group distribution, increased inpatient evaluation and management services, higher utilization of inpatient rehabilitation, and patients with multiple readmissions. Conclusions and Relevance Wide variation exists in 90-day CABG episode payments for Medicare and private payer patients in Michigan. Hospitals and clinicians entering bundled payment programs for CABG should work to understand local sources of variation, with a focus on patients with multiple readmissions, inpatient evaluation and management services, and postdischarge outpatient rehabilitation care.
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Affiliation(s)
- Vinay Guduguntla
- Medical Student, School of Medicine, University of Michigan, Ann Arbor
- Michigan Value Collaborative, University of Michigan, Ann Arbor
| | | | - Chad Ellimoottil
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - David C. Miller
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Richard L. Prager
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, University of Michigan, Ann Arbor
- Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor
- Section of Adult Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor
| | - Edward C. Norton
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Health Management and Policy, University of Michigan, Ann Arbor
- Department of Economics, University of Michigan, Ann Arbor
| | - Patricia Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, University of Michigan, Ann Arbor
| | - Donald S. Likosky
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor
| | - James M. Dupree
- Michigan Value Collaborative, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
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Alqahtani F, Aljohani S, Almustafa A, Alhijji M, Ali O, Holmes DR, Alkhouli M. Comparative outcomes of transcatheter aortic valve replacement in
A
frican
A
merican and
C
aucasian patients with severe aortic stenosis. Catheter Cardiovasc Interv 2017; 91:932-937. [DOI: 10.1002/ccd.27257] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/06/2017] [Accepted: 07/29/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Fahad Alqahtani
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
| | - Sami Aljohani
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
| | - Ahmad Almustafa
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
| | - Mohammed Alhijji
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
| | - Oluseun Ali
- Novant Health Heart & Vascular InstituteCharlotteNorth Carolina
| | - David R. Holmes
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
| | - Mohamad Alkhouli
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
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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 2016; 8:495-506. [PMID: 27703385 PMCID: PMC5036826 DOI: 10.2147/ceor.s89331] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Robust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events. METHODS MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest - unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values. RESULTS Across the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union. CONCLUSION This review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed.
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Shinjo D, Fushimi K. Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis. BMJ Open 2015; 5:e008750. [PMID: 26576810 PMCID: PMC4654398 DOI: 10.1136/bmjopen-2015-008750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the effect of preoperative patient and hospital factors on resource use, cost and length of stay (LOS) among patients undergoing off-pump coronary artery bypass grafting (OPCAB). DESIGN Observational retrospective study. SETTINGS Data from the Japanese Administrative Database. PARTICIPANTS Patients who underwent isolated, elective OPCAB between April 2011 and March 2012. PRIMARY OUTCOME MEASURES The primary outcomes of this study were inpatient cost and LOS associated with OPCAB. A two-level hierarchical linear model was used to examine the effects of patient and hospital characteristics on inpatient costs and LOS. The independent variables were patient and hospital factors. RESULTS We identified 2491 patients who underwent OPCAB at 268 hospitals. The mean cost of OPCAB was $40 665 ±7774, and the mean LOS was 23.4±8.2 days. The study found that select patient factors and certain comorbidities were associated with a high cost and long LOS. A high hospital OPCAB volume was associated with a low cost (-6.6%; p=0.024) as well as a short LOS (-17.6%, p<0.001). CONCLUSIONS The hospital OPCAB volume is associated with efficient resource use. The findings of the present study indicate the need to focus on hospital elective OPCAB volume in Japan in order to improve cost and LOS.
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Affiliation(s)
- Daisuke Shinjo
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Gheorghe A, Roberts T, Hemming K, Calvert M. Evaluating the Generalisability of Trial Results: Introducing a Centre- and Trial-Level Generalisability Index. PHARMACOECONOMICS 2015; 33:1195-1214. [PMID: 26068945 DOI: 10.1007/s40273-015-0298-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Few randomised controlled trials (RCTs) recruit centres representatively, which may limit the external validity of trial results. OBJECTIVE The aim of this study was to propose a proof-of-concept method of assessing the generalisability of the clinical and cost-effectiveness findings of a given RCT. METHODS We developed a generalisability index (Gix), informed by centre-level characteristics, as a measure of centre and trial representativeness. The centre-level Gix quantifies how representative a centre is in relation to its jurisdiction, e.g. a country or health authority. The trial-level Gix quantifies how representative trial recruitment is in relation to clinical practice in the jurisdiction. Taking a real-world RCT as a case study and assuming trial-wide results to represent 'true jurisdiction values', we used simulation methods to recreate 5000 RCTs and investigate the relationship between trial representativeness, reflected by the standardised trial-Gix, and the deviation of simulated trial results from the 'true values'. RESULTS The simulation study provides evidence that trial results (odds ratio for the primary outcome and incremental quality-adjusted life-years) were influenced by the representativeness of the sample of recruiting centres. Simulated RCTs with the closest results to the 'true values' were those whose recruitment closely mirrored the jurisdiction-wide context. Results appeared robust to six alternative specifications of the Gix. CONCLUSIONS Our findings suggest that an unrepresentative selection of centres limits the external validity of trial results. The Gix may be a valuable tool to help facilitate rational selection of trial centres and ensure the generalisability of results at the jurisdiction level.
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Affiliation(s)
- Adrian Gheorghe
- Primary Care Clinical Sciences and MRC Midlands Hub for Trials Methodology Research, University of Birmingham, Birmingham, UK.
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Public Health, Epidemiology and Statistics, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Primary Care Clinical Sciences and MRC Midlands Hub for Trials Methodology Research, University of Birmingham, Birmingham, UK
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Aquina CT, Probst CP, Kelly KN, Iannuzzi JC, Noyes K, Fleming FJ, Monson JRT. The pitfalls of inguinal herniorrhaphy: Surgeon volume matters. Surgery 2015; 158:736-46. [PMID: 26036880 DOI: 10.1016/j.surg.2015.03.058] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is currently little information regarding the impact of procedure volume on outcomes after open inguinal hernia repair in the United States. Our hypothesis was that increasing procedure volume is associated with lesser rates of reoperation and resource use. METHODS The database of the Statewide Planning and Research Cooperative System was queried for elective open initial inguinal hernia repairs performed in New York State from 2001 to 2008 via the use of International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. Surgeon and hospital procedure volumes were grouped into tertiles based on the number of open inguinal hernia repairs performed per year. Bivariate, hierarchical mixed effects Cox proportional-hazards, and negative binomial regression analyses were performed assessing for factors associated with reoperation for recurrence, procedure time, and downstream total charges. RESULTS Among 151,322 patients who underwent open inguinal hernia repair, the overall rate of reoperation for recurrence within 5 years was 1.7% with a median time to reoperation of 1.9 years. An inverse relationship was seen between surgeon volume and reoperation rate, procedure time, and health care costs (P < .001). After we controlled for surgeon, facility, operative and patient characteristics, low-volume surgeons (<25 repairs/year) had greater rates of reoperation (hazard ratio 1.23,95% confidence interval [95% CI] 1.11-1.36), longer procedure times (incidence rate ratio 1.22, 95% CI 1.21-1.24), and greater downstream costs (incidence rate ratio 1.13,95% CI 1.10-1.17) than high-volume surgeons (≥25 repairs/year). CONCLUSION Surgeon volume <25 cases per year for open inguinal hernia repair was independently associated with greater rates of reoperation for recurrence, worse operative efficiency, and greater health care costs. Referral to surgeons who perform ≥25 inguinal hernia repairs per year should be considered to decrease reoperation rates and resource use.
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Affiliation(s)
- Christopher T Aquina
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY.
| | - Christian P Probst
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY
| | - Kristin N Kelly
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY
| | - James C Iannuzzi
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY
| | - Katia Noyes
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY
| | - Fergal J Fleming
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY
| | - John R T Monson
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY
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Kilic A, Shah AS, Conte JV, Mandal K, Baumgartner WA, Cameron DE, Whitman GJ. Understanding variability in hospital-specific costs of coronary artery bypass grafting represents an opportunity for standardizing care and improving resource use. J Thorac Cardiovasc Surg 2014; 147:109-15. [DOI: 10.1016/j.jtcvs.2013.08.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/28/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
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Vassileva CM, Shabosky J, Boley T, Markwell S, Hazelrigg S. Cost Analysis of Isolated Mitral Valve Surgery in the United States. Ann Thorac Surg 2012; 94:1429-36. [DOI: 10.1016/j.athoracsur.2012.05.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/17/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Mather RC, Wysocki RW, Mack Aldridge J, Pietrobon R, Nunley JA. Effect of facility on the operative costs of distal radius fractures. J Hand Surg Am 2011; 36:1142-8. [PMID: 21620585 DOI: 10.1016/j.jhsa.2011.03.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate whether ambulatory surgery centers can deliver lower-cost care and to identify sources of those cost savings. METHODS We performed a cost identification analysis of outpatient volar plating for closed distal radius fractures at a single academic medical center. Multiple costs and time measures were taken from an internal database of 130 consecutive patients and were compared by venue of treatment, either an inpatient facility or an ambulatory, stand-alone surgery facility. The relationships between total cost and operative time and multiple variables, including fracture severity, patient age, gender, comorbidities, use of bone graft, concurrent carpal tunnel release, and surgeon experience, were examined, using multivariate analysis and regression modeling to identify other cost drivers or explanatory variables. RESULTS The mean operative cost was considerably greater at the inpatient facility ($7,640) than at the outpatient facility ($5,220). Cost drivers of this difference were anesthesia services, post-anesthesia care unit, and operating room costs. Total surgical time, nursing time, set-up, and operative times were 33%, 109%, 105%, and 35% longer, respectively, at the inpatient facility. There was no significant difference between facilities for the additional variables, and none of those variables independently affected cost or operative time. CONCLUSIONS The only predictor of cost and time was facility type. This study supports the use of ambulatory stand-alone surgical facilities to achieve efficient resource utilization in the operative treatment of distal radius fractures. We also identified several specific costs and time measurements that differed between facilities, which can serve as potential targets for tertiary facilities to improve utilization. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decisional Analysis III.
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Affiliation(s)
- Richard C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Chung WC, Fan PL, Chiu HC, Yang CY, Huang KL, Tzeng DS. Operating room cost for coronary artery bypass graft procedures: does experience or severity of illness matter? J Eval Clin Pract 2010; 16:1063-70. [PMID: 20630000 DOI: 10.1111/j.1365-2753.2009.01251.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Very few studies have addressed the magnitude of the effect of the condition of the patients and the surgical volume on possible cost savings in coronary artery bypass grafting (CABG). The objectives of this study were to analyse and compare the costs of the CABG operating room (OR) between two hospitals, and to examine the effect of surgical volume and severity of illness on the OR costs. METHOD The charts of patients who were diagnosed with coronary artery disease and who underwent CABG at two acute tertiary care hospitals in 2004 were reviewed retrospectively. Data on patient demographics, length of stay (LOS) and the American Society of Anesthesiologists Physical Status (ASAPS) score were extracted from the patient records. Cost information was obtained from detailed billing charges and from the financial accounting divisions of the hospitals. RESULTS The high-volume hospital consumed fewer resources than the low-volume hospital (US$5411 vs. US$6407). The age of the patients, surgical volume, operating hours and LOS were associated with the OR cost. Patient age and ASAPS score, hospital, and surgical volume were associated with LOS. Patient age, the number of diseased vessels, doctor volume and pump used or not were positively associated with the operation time. The LOS and the operation time may be the mediators of the relationship between the ASAPS score and cost, and may moderate the association of volume with cost. CONCLUSIONS This study supports the saying that 'practice makes perfect'. The knowledge and experience of the surgeons and the hospital management team are equally important in the supply of health services to patients with varying severity of illness, and are needed to maintain the competitive position of a hospital.
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Affiliation(s)
- Wei-Ching Chung
- Department of Nursing, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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