News | June 16, 2008

Complications Post-Cardiac Surgery Increase Costs More than Two-Thirds

June 17, 2008 - Major complications following coronary artery bypass graft (CABG) surgery, even among patients least at risk of experiencing complications, remain common and add significantly to healthcare costs, as well as diminish the benefits of surgery, according to research funded and conducted by Cardiac Data Solutions, which was published in the June 2008 Annals of Thoracic Surgery.

According to the study, the average cost of a patient undergoing isolated CABG without a perioperative complication in fiscal year 2005 was $29,477. The average incremental cost for a patient suffering one of the seven complications studied was $19,968, and the average length of stay increased from 9 days to 15.9 days.

Although mortality rates associated with CABG continue to decline, 13.64 percent of beneficiaries undergoing isolated CABG in FY 2005, or 15,579 patients, experienced one or more of seven complications studied, resulting in a total incremental annual cost to Medicare of more than $311 million.

Based on current trends, the Medicare Trust Fund is expected to be exhausted by 2019, prompting the Centers for Medicare and Medicaid Services (CMS) to no longer pay for certain avoidable complications, beginning in October of this year.

“Complications after cardiac surgery are costly… in terms of decreasing the benefit of surgery [and]… greatly increasing the financial burden of providing cardiac surgical care,” says Hari Mallidi, M.D., department of cardiothoracic surgery, Stanford University, who provided commentary on the research. “As CMS attempts to further reduce costs in the future, there may be implications for payment with respect to the noninfectious complications that occur after cardiac surgery. If a concerted effort is made by the hospital to ensure that compliance with evidence-based approaches to decreasing perioperative infections are implemented for every cardiac surgical patient, then a decrease in infection rate might be realized.”

Of the seven complications studied, the most common was also among the most expensive to treat: post operative adult respiratory distress syndrome (ARDS), which added an average of $22,222 in hospital costs per patient or more than $111 million in incremental Medicare costs in FY 2005. The most expensive complication studied was septicemia with an incremental cost of $59,204. Both septicemia and ARDS are similar in nature to complications CMS has proposed adding to the list of non-reimbursable events beginning in October, 2008. The two other most common complications studied were hemorrhage or postoperative shock and reoperation. Additional complications studied were: new onset dialysis, post operative stroke and post operative infection. Among the patients studied, those most likely to experience complications were older than 75, female and/or non-white.

The research underscores the value of hospitals implementing quality improvement initiatives to reduce the average cost of care and improve patient outcomes,” said Cardiac Data Solutions founder, April Simon, RN, who was also among the researchers. “Quality improvement initiatives will become increasingly important as CMS expands the number of avoidable complications for which it will not provide incremental reimbursement”. A recent CDS study found that even with additional reimbursement, hospitals are not able to recover the costs of certain complications related to revascularization procedures.

The researchers, led by Phillip P. Brown, cardiovascular surgeon (retired) and past chairman, department of surgery, Centennial Medical Center, studied 114,233 Medicare beneficiaries who survived CABG without concomitant valve repair in hospitals that each performed at least 52 such procedures during FY 2005.

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