Edwin Fonner

Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery

BACKGROUND Efforts to reduce blood product use have the potential to avoid transfusion-related complications and reduce health care costs. The purpose of this investigation was to determine whether a multi-institutional effort to reduce blood product use affects postoperative events after cardiac surgical operations and to determine the influence of perioperative transfusion on risk-adjusted outcomes. METHODS A total of 14,259 patients (2006-2010) undergoing nonemergency, primary, isolated coronary artery bypass grafting operations at 17 different statewide cardiac centers were stratified according to transfusion guideline era: pre-guideline (n = 7059, age = 63.7 ± 10.6 years) versus post-guideline (n = 7200, age = 63.7 ± 10.5 years). Primary outcomes of interest were observed differences in postoperative events and mortality risk-adjusted associations as estimated by multiple regression analysis. RESULTS Overall intraoperative (24% vs 18%, P < .001) and postoperative (39% vs 33%, P < .001) blood product transfusion were significantly reduced in the post-guideline era. Patients in the post-guideline era demonstrated reduced morbidity with decreased pneumonia (P = .01), prolonged ventilation (P = .05), renal failure (P = .03), new-onset hemodialysis (P = .004), and composite incidence of major complications (P = .001). Operative mortality (1.0% vs 1.8%, P < .001) and postoperative ventilation time (22 vs 26 hours, P < .001) were similarly reduced in the post-guideline era. Of note, after mortality risk adjustment, operations performed in the post-guideline era were associated with a 47% reduction in the odds of death (adjusted odds ratio, 0.57; P < .001), whereas the risk of major complications and mortality were significantly increased after intraoperative (adjusted odds ratio, 1.86 and 1.25; both P < .001) and postoperative (adjusted odds ratio, 4.61 and 4.50, both P < .001) transfusion. Intraoperative and postoperative transfusions were associated with increased adjusted incremental total hospitalization costs (

Additive Costs of Postoperative Complications for Isolated Coronary Artery Bypass Grafting Patients in Virginia

4408 and

Postoperative Atrial Fibrillation Significantly Increases Mortality, Hospital Readmission, and Hospital Costs

10,479, respectively). CONCLUSIONS Implementation of a blood use initiative significantly improves postoperative morbidity, mortality, and resource utilization. Limiting intraoperative and postoperative blood product transfusion decreases adverse postoperative events and reduces health care costs. Blood conservation efforts are bolstered by collaboration and guideline development.

Performance of EuroSCORE II in a large US database: implications for transcatheter aortic valve implantation

BACKGROUND Complications after open-heart surgery result in an increased length of stay and greater financial burdens for all. The purpose of this study was to measure the additive costs of postoperative complications for selected subgroups of patients after coronary artery bypass grafts in the Commonwealth of Virginia. METHODS A multiyear statewide data repository with clinical and billing data was used to measure outcomes for the period 2004 to 2007. The Society of Thoracic Surgeons records matched with Universal Billing (UB-04) charge data for all payers were used to estimate the additive costs of cardiac surgical outcomes using cost-to-charge ratios. Additive cost was defined as the difference between the baseline cost of an average case with no complications and one with a postoperative morbidity or mortality. Multivariate analysis was used to account for important covariates and apportion incremental costs. RESULTS The baseline cost of isolated coronary artery bypass grafting (CABG) cases with no complications during the study period was

Costs for Surgical Aortic Valve Replacement According to Preoperative Risk Categories

26,056. Isolated atrial fibrillation was the most frequently cited complication and had the lowest additive cost (

Regional collaboration as a model for fostering accountability and transforming health care.

2,574). Additive costs for isolated CABG patients were greatest for those cases involving prolonged ventilation (

Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis

40,704), renal failure (

A Contemporary Cost Analysis of Postoperative Morbidity After Coronary Artery Bypass Grafting With and Without Concomitant Aortic Valve Replacement to Improve Patient Quality and Cost-Effective Care

49,128), mediastinitis (

Outcomes and Cost of Cardiac Surgery in Octogenarians is Related to Type of Operation: A Multiinstitutional Analysis

62,773), and operative mortality (

Preoperative Beta-Blocker Use Should Not Be a Quality Metric for Coronary Artery Bypass Grafting

49,242). CONCLUSIONS Additive costs can serve as an indicator for pursuing quality improvement initiatives. Our results suggest additive costs vary according to type of postoperative complication and comorbidities. Regional collaborations of multidisciplinary groups in cardiac surgery are an effective means to implement quality guidelines and drive down additive costs.