Perioperative predictors of ICU and hospital costs in coronary artery bypass graft surgery.

STUDY

OBJECTIVE

Economic forces have precipitated intense interest in cost-saving practices for patients undergoing coronary artery bypass grafting (CABG). While several preoperative variables have been implicated in higher costs, few studies have included perioperative factors. This study evaluated the predictive power of a preoperative mortality risk measurement (Parsonnet score) and of early extubation (< or = 6 h from ICU admission) in determining ICU and hospital costs.

DESIGN

Multivariate correlational design.

SETTING

University hospital in a large metropolitan area.

PATIENTS: All patients (n = 116) undergoing isolated CABG during a 6-month period were studied after the introduction of a clinical pathway.

MEASUREMENTS AND

RESULTS

Clinical data were collected. Costs data were obtained retrospectively from the institutional data system and were derived from individual patient charges by application of department-specific cost-to-charge ratios. In multivariate logistic regression, Parsonnet score (per point odds ratio [OR], 1.09; confidence interval [CI], 1.03 to 1.17), in-hospital coronary angiography (OR, 3.51; CI, 1.23 to 10.01), delayed extubation (OR, 4.59; CI, 1.29 to 16.29), and presence of arrhythmia (OR, 3.50; CI, 1.15 to 10.64) were independent predictors of ICU costs. Only Parsonnet score (OR, 1.09; CI, 1.03 to 1.15) and cardiopulmonary bypass time (OR, 1.01; CI, 1.00 to 1.02) were independent predictors of hospital costs.

CONCLUSIONS

The Parsonnet score is a useful indicator of both ICU and hospital costs. Early extubation is associated with decreased ICU costs, but is not independently predictive of hospital costs.