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Perioperative Predictors of ICU and Hospital Costs in Coronary Artery Bypass Graft Surgery^*

^* From the School of Nursing (Dr. Doering), and School of Medicine (Drs. Esmailian and Laks), University of California, Los Angeles, Los Angeles, CA.

Correspondence to: Lynn V. Doering, RN, DNSc, Assistant Professor, Acute Care, Factor Building 4–250, PO Box 956918, Los Angeles, CA 90095-6918; e-mail: ldoering{at}sonnet.ucla.edu

Study objective: Economic forces have precipitated intense interest in cost-saving practices for patients undergoing coronary artery bypass grafting (CABG). While several preoperative variables have been implicated in higher costs, few studies have included perioperative factors. This study evaluated the predictive power of a preoperative mortality risk measurement (Parsonnet score) and of early extubation ( 6 h from ICU admission) in determining ICU and hospital costs.

Design: Multivariate correlational design.

Setting: University hospital in a large metropolitan area.

Patients: All patients (n = 116) undergoing isolated CABG during a 6-month period were studied after the introduction of a clinical pathway.

Measurements and results: Clinical data were collected. Costs data were obtained retrospectively from the institutional data system and were derived from individual patient charges by application of department-specific cost-to-charge ratios. In multivariate logistic regression, Parsonnet score (per point odds ratio [OR], 1.09; confidence interval [CI], 1.03 to 1.17), in-hospital coronary angiography (OR, 3.51; CI, 1.23 to 10.01), delayed extubation (OR, 4.59; CI, 1.29 to 16.29), and presence of arrhythmia (OR, 3.50; CI, 1.15 to 10.64) were independent predictors of ICU costs. Only Parsonnet score (OR, 1.09; CI, 1.03 to 1.15) and cardiopulmonary bypass time (OR, 1.01; CI, 1.00 to 1.02) were independent predictors of hospital costs.

Conclusions: The Parsonnet score is a useful indicator of both ICU and hospital costs. Early extubation is associated with decreased ICU costs, but is not independently predictive of hospital costs.

Key Words: coronary artery bypass graft • costs • extubation • mortality risk

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