title: Impact of patient characteristics, complications, and facility volume on the costs and time of cardiac catheterization and coronary angioplasty in 70 catheterization laboratories.
abstract: Although over 1 million procedures are performed in cardiac catheterization laboratories (CCLs) annually, little comparative data exist on costs or resource use in these settings. In this study, data from 70 CCLs were used to profile CCL times and total direct costs for 2 high-volume procedures: left heart catheterization (LHC) and percutaneous transluminal coronary angioplasty (PTCA) with or without stent placement. In total, 70,677 consecutive patient examinations for a 12-month period from January 1, 1998 to December 31, 1998 were analyzed. For LHC mean total direct costs averaged $306, whereas for PTCA catheterization laboratory costs averaged $3,172. The average total times for these procedures were 63 and 108 minutes, respectively. Seventy-two percent of the PTCA patients underwent coronary stenting with an associated incremental cost of $1,244. By multivariate linear regression, baseline patient characteristics such as age, gender, and clinical factors had little impact on total time and total costs. The major determinants of CCL time and cost were procedural factors (e.g., number and type of interventions) and in-lab complications, including profound hypotension, abrupt vessel closure, and emergency bypass surgery. Using facility procedure volume as a proxy for potential economies of scale, we found no relation between CCL volume and total direct CCL costs. There did appear to be a significant inverse relation between facility volume and total procedural time with CCLs that performed the highest volumes of LHC and PTCA procedures saving an average of 5 to 9 minutes per procedure. These findings may be useful in defining specific time and cost benchmarks for these commonly performed procedures and serve to underscore the critical role of reducing complications in both quality improvement and cost-saving efforts.
authors.affiliation: Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. djc@hsph.harvard.edu
authors.forename: D J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: E R
authors.initials: ER
authors.lastname: Becker
authors.forename: S D
authors.initials: SD
authors.lastname: Culler
authors.forename: S
authors.initials: S
authors.lastname: Ellis
authors.forename: L M
authors.initials: LM
authors.lastname: Green
authors.forename: R N
authors.initials: RN
authors.lastname: Schnitzler
authors.forename: A W
authors.initials: AW
authors.lastname: Simon
authors.forename: W S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000706:statistics & numerical data; D002300:Cardiac Care Facilities / Q000191:economics / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000191:economics* / Q000706:statistics & numerical data; D017046:Cost Savings / Q000191:economics; D004180:Direct Service Costs / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies