920-47 The Monetary Cost of Complications After Bypass Surgery: The Achilles’ Heel of Contract Pricing

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.97A-97A
• Main Authors: Denton, Timothy A., Diamond, George A., Matloff, Jack M.
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)91856-S

Contract pricing among providers is being used as a method to control the costs of health care. To estimate a contract price. providers must take into account not only the direct costs of uncomplicated procedures. but the incremental costs of complications. Accordingly, we determined the incremental costs of postoperative complications in a series of 722 consecutive patients (3/12/90 to 3/22/94) undergoing routine CABG (DRG 107–CABG without catheterization). We identified 31 prospectively collected candidate variables from the perioperative period and 15 routinely collected complications. Total direct costs were obtained from the hospital central financial system. Only patients who survived to discharge were included in the analysis. Forward, stepwise, multiple linear regression was used to determine the incremental costs of complications above the cost of an uncomplicated procedure. Of the candidate variables. 6 perioperative variables (age, angina CHA class, non-use of internal thoracic artery, widow(er), peripheral vascular disease, hypercholesterolemia), and 6 complications contributed to the direct costs of CABG. The following table shows the incremental cost of each postoperative complication and its percent of the average direct cost of CABG ($27,400).New dialysis$36,436133%Any neuro compl$13,33349%Intubated>48 hrs$24,53590%Leg infection$ 5.05518%Pneumonia$20,84776%SVT$ 2,67010% Postoperative complications add large, incremental costs to CABG surgery, and can be more expensive than the basic direct costs of the procedure itself. By knowing the incidence and costs of complications, contract prices can be adjusted to more accurately reflect true direct costs.