Cost reduction in cardiac surgery.
OBJECTIVE
To reduce surgical waiting lists at the University of Alberta Hospitals. A cost reduction program was initiated, allowing more cases to be performed on the same budget. Reducing the cost of delivering health care services has become necessary as demands upon the system increase.


METHODS
Data were retrospectively gathered on patients having open heart surgery at the University of Alberta Hospitals between March 1, 1991 and February 29, 1992. Group 1 were patients operated on before the start of the cost reduction program (September 1, 1991) and group 2 were those operated on after. Student's t test and logistic regression were use to compare population characteristics and to correlate dependent variables.


RESULTS
Demographic features and severity indices were not different. Operating time decreased from 4.5 +/- 1.5 to 4 +/- 1 h, P < 0.002. Preoperative, intensive care unit (ICU) and postoperative ward length of stay were reduced (P < 0.002). Total length of stay went from 19.3 +/- 22.7 to 13.8 +/- 10.7 days, P < 0.001. Operating room, nursing and x-ray costs decreased, P < 0.002. Hospital costs declined from $14,182 +/- 16,464 to $10,710 +/- 7,332, P < 0.001. Multiple regression showed hospital stay, ICU, operating room time, severity of illness and age to be significant determinants of cost, P < 0.03 for each. Waiting time and number of patients on the waiting list declined significantly as surgical lists increased. Mortality and rate of readmission following discharge were not different between the two groups.


CONCLUSIONS
Substantial cost savings can be made by changing practice patterns, without adverse consequences. ICU and hospital length of stay are the most important cost determinants.
Hamilton
A
A
University of Alberta Hospitals, Edmonton.
Norris
C
C
Wensel
R
R
Koshal
A
A
D000416:Alberta; D001807:Blood Vessel Prosthesis; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000401:mortality; D016507:Cardiology Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass; D003363:Cost Control / Q000379:methods; D017598:Efficiency, Organizational / Q000191:economics; D005260:Female; D006302:Health Services Research; D016027:Heart Transplantation; D006350:Heart Valve Prosthesis; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011383:Progressive Patient Care / Q000191:economics*; D014850:Waiting Lists