Hospital resource consumption in patients with diabetes and multivessel coronary disease undergoing revascularization.
OBJECTIVE
To identify factors responsible for the variation in real hospital costs and length of stay for patients with diabetes undergoing coronary angioplasty or coronary bypass surgery.


METHODS
Retrospective study of patients with diabetes and coronary artery disease treated at a single hospital.


METHODS
The study population included 1809 patients with diabetes and multivessel (2-vessel or 3-vessel) coronary artery disease who underwent an initial coronary angioplasty or coronary bypass surgery between 1988 and 1996. After accounting for the extent and severity of the patient's coronary artery disease, a sequential model was used to assess if diabetic characteristics were independently associated with higher hospital resource utilization during revascularization.


RESULTS
Multivariate regression results indicated that for patients with diabetes who underwent coronary angioplasty, a baseline creatinine level of > or = 2.0 mg/dL was associated with significantly higher hospital costs and longer length of stay. For patients with diabetes who underwent a coronary bypass surgery only, a baseline creatinine level of > or = 2.5 mg/dL was associated with higher hospital costs and longer hospital length of stay.


CONCLUSIONS
After controlling for coronary risk factors, selected diabetes-specific characteristics are associated with higher hospital resource utilization. Risk adjustments in hospital reimbursement may be needed to assure that patients with diabetes who have cardiovascular disease have access to revascularization procedures.
Culler
S D
SD
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. sculler@sph.emory.edu
Weintraub
W S
WS
Shaw
L J
LJ
Becker
E R
ER
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D001026:Coronary Artery Bypass / Q000191:economics*; D003327:Coronary Disease / Q000150:complications / Q000191:economics* / Q000601:surgery; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014600:Utilization Review