Regional Variability of In-Patient Outcomes for Coronary Artery Bypass in the United States
Ahmed Ali1, Anahita Dua1, Dustin Hang1, Sapan Desai2. 1Medical college of WI affiliated hospitals, Wauwatosa, WI USA, 2Southern Illinois University, Carbondale, IL USA.
Objective: This study aimed to determine the impact of regional variation on in-patient outcomes and cost in patients undergoing coronary artery bypass grafting (CABG) in the USA.
Methods: A retrospective analysis was completed using the 2008-2012 Nationwide Inpatient Sample (NIS) utilizing International Classification of Diseases-9 codes to select patients with coronary atherosclerosis (414.00-414.03) who underwent elective CABG (36.10-36.15). Variables included demographics, procedure type, outcome during hospital course, cost, length of stay, and location (Northeast, Midwest, South, West). Statistical analysis was with chi-square, Fisher exact test, and multivariate analysis.
Results: A total of 609,320 CABG procedures were performed over the 4 year study period in the USA the majority of which were in the Southern region (268,590) with the lowest number of CABGs being performed in western region (91,620). There were no significant regional differences in the demographics, complications, LOS or mortality. However, cost of CABG was found to be significantly elevated in the west ($55,264 +/- 34,590, p<0.001) when compared to the other 3 regions (median ,928 +/- 28,425). The largest impact on cost was CHF (r2 = 0.93; p<0.001), followed by SSI (r2 = 0.87;p<0.001), bleeding (r2 = 0.74; P 75 (r2 = 0.71; p<0.001).
Conclusions: There is a considerable regional variation in the cost of performing CABG in the United States after adjusting for the demographics and clinical characteristics. The Western region performs the procedure for almost $20,000 more than their counterparts in Northeast.