Relationship between routine multi-detector cardiac computed tomographic angiography prior to reoperative cardiac surgery, length of stay, and hospital charges.
Relationship between routine multi-detector cardiac computed tomographic angiography prior to reoperative cardiac surgery, length of stay, and hospital charges.
,217 (1,325-5,353) p < 0.001] and nursing charges [ While multi-detector cardiac computed tomography angiography (MDCCTA) prior to reoperative cardiac surgery (RCS) has been associated with improved clinical outcomes, its impact on hospital charges and length of stay remains unclear. We studied 364 patients undergoing RCS at Washington Hospital Center between 2004 and 2008, including 137 clinically referred for MDCCTA. Baseline demographics, procedural data, and perioperative outcomes were recorded at the time of the procedure. The primary clinical endpoint was the composite of perioperative death, myocardial infarction (MI), stroke, and hemorrhage-related reoperation. Secondary clinical endpoints included surgical procedural variables and the perioperative volume of bleeding and transfusion. Length of stay was determined using the hospital's electronic medical record. Cost data were extracted from the hospital's billing summary. Analysis was performed on individual categories of care, as well as on total hospital charges. Data were compared between subjects with and without MDCCTA, after adjustment for the Society of Thoracic Surgeons score. Baseline characteristics were similar between the two groups. MDCCTA was associated with shorter procedural times, shorter intensive care unit stays, fewer blood transfusions, and less frequent perioperative MI. There was additionally a trend towards a lower incidence of the primary endpoint (17.5 vs. 24.2 %, p = 0.13) primarily due to a lower incidence of perioperative MI (0 vs. 5.7 %, p = 0.002). MDCCTA was also associated with lower median recovery room [
1569-5794
*Cardiac Surgical Procedures/ec [Economics]
*Coronary Angiography/ec [Economics]
*Hospital Costs
*Length of Stay/ec [Economics]
*Multidetector Computed Tomography/ec [Economics]
*Postoperative Complications
Aged
Cardiac Surgical Procedures/ae [Adverse Effects]
Cardiac Surgical Procedures/mo [Mortality]
Chi-Square Distribution
Coronary Angiography/mt [Methods]
Cost Savings
District of Columbia
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications/ec [Economics]
Postoperative Complications/mo [Mortality]
Postoperative Complications/ra [Radiography]
Postoperative Complications/su [Surgery]
Predictive Value of Tests
Preoperative Care/ec [Economics]
Reoperation
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Anesthesiology
Medicine
Journal Article
,217 (1,325-5,353) p < 0.001] and nursing charges [ While multi-detector cardiac computed tomography angiography (MDCCTA) prior to reoperative cardiac surgery (RCS) has been associated with improved clinical outcomes, its impact on hospital charges and length of stay remains unclear. We studied 364 patients undergoing RCS at Washington Hospital Center between 2004 and 2008, including 137 clinically referred for MDCCTA. Baseline demographics, procedural data, and perioperative outcomes were recorded at the time of the procedure. The primary clinical endpoint was the composite of perioperative death, myocardial infarction (MI), stroke, and hemorrhage-related reoperation. Secondary clinical endpoints included surgical procedural variables and the perioperative volume of bleeding and transfusion. Length of stay was determined using the hospital's electronic medical record. Cost data were extracted from the hospital's billing summary. Analysis was performed on individual categories of care, as well as on total hospital charges. Data were compared between subjects with and without MDCCTA, after adjustment for the Society of Thoracic Surgeons score. Baseline characteristics were similar between the two groups. MDCCTA was associated with shorter procedural times, shorter intensive care unit stays, fewer blood transfusions, and less frequent perioperative MI. There was additionally a trend towards a lower incidence of the primary endpoint (17.5 vs. 24.2 %, p = 0.13) primarily due to a lower incidence of perioperative MI (0 vs. 5.7 %, p = 0.002). MDCCTA was also associated with lower median recovery room [
1569-5794
*Cardiac Surgical Procedures/ec [Economics]
*Coronary Angiography/ec [Economics]
*Hospital Costs
*Length of Stay/ec [Economics]
*Multidetector Computed Tomography/ec [Economics]
*Postoperative Complications
Aged
Cardiac Surgical Procedures/ae [Adverse Effects]
Cardiac Surgical Procedures/mo [Mortality]
Chi-Square Distribution
Coronary Angiography/mt [Methods]
Cost Savings
District of Columbia
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications/ec [Economics]
Postoperative Complications/mo [Mortality]
Postoperative Complications/ra [Radiography]
Postoperative Complications/su [Surgery]
Predictive Value of Tests
Preoperative Care/ec [Economics]
Reoperation
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Anesthesiology
Medicine
Journal Article