title: Resource utilization in coronary artery bypass operation: does surgical risk predict cost?
abstract: BACKGROUND
  Current healthcare trends may render financial risk of cardiac operation a key component of clinical decision making. It has been suggested, based on large cohorts of patients stratified by clinical risk, that the cost of operation can be predicted from models of clinical risk since length of stay (LOS) is highly correlated to clinical risk, and LOS is correlated to hospital costs and charges. Direct correlation of actual surgical costs with surgical risk are lacking.
  
  
  METHODS
  Variable direct costs, LOS, and The Society of Thoracic Surgeons predicted mortality risk [STS risk (%)] were collected and analyzed in 628 consecutive patients undergoing coronary artery bypass grafting (CABG) at our institution in 1997.
  
  
  RESULTS
  Cost of CABG had a near-normal distribution, and cost in 21 outlier patients (cost > two standard deviations above the mean) was an average 5.3 times normal (median cost). For individual patients, cost was well correlated to LOS (R2 = 0.48) but not with STS risk (R2 = 0.12). LOS was also poorly predicted by STS risk (R2 = 0.09). However, despite its poor prediction of cost, STS risk was an unbiased estimator over the entire population. A result manifested, when patients were grouped into similar risk (<1%, 1-2%, 2+ -3%, 3+ -5%, 5+ -10%, and >10%) cohorts, by high correlation between cost and STS risk (R2 = 0.99), cost and LOS risk (R2 = 0.99), and LOS and STS risk (R2 = 0.97).
  
  
  CONCLUSIONS
  Our data demonstrated that, in large CABG cohorts, surgical risk models can accurately predict cost of CABG. However, despite a trend for increasing cost with increasing STS risk, surgical risk models based on preoperative data are poor predictors of cost in individual patients. Use of these models should be limited to analysis of cost trends in cardiac operation, but not for predicting financial risk in individual patients during clinical decision making.
authors.affiliation: Department of Cardiovascular Surgery, St. Vincent Mercy Medical Center, and Medical College of Ohio, Toledo 43608, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Riordan
authors.forename: M
authors.initials: M
authors.lastname: Engoren
authors.forename: A
authors.initials: A
authors.lastname: Zacharias
authors.forename: T A
authors.initials: TA
authors.lastname: Schwann
authors.forename: G L
authors.initials: GL
authors.lastname: Parenteau
authors.forename: S J
authors.initials: SJ
authors.lastname: Durham
authors.forename: R H
authors.initials: RH
authors.lastname: Habib
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000191:economics*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009820:Ohio; D018570:Risk Assessment