The economic burden of complications during percutaneous coronary intervention.
BACKGROUND
Technological advances have enabled percutaneous coronary intervention (PCI) to be applied with expanding indications. However, escalating costs are of concern. This study assessed the incremental medical costs of major in-hospital procedural complications incurred by patients undergoing PCI.


METHODS
We considered all patients undergoing elective, urgent, or emergent PCI at Mayo Clinic Rochester between 3/1/1998-3/31/2003 in analyses. Clinical, angiographic, and outcome data were derived from the Mayo Clinic PCI Registry. In-hospital PCI complications included major adverse cardiac and cerebrovascular events (MACCE) and bleeding of clinical significance. Administrative data were used to estimate total costs in standardised, year 2004, constant-US dollars. We used generalised linear modeling to estimate costs associated with complications adjusting for baseline and procedural characteristics.


RESULTS
1071 (13.2%) of patients experienced complications during hospitalisation. Patients experiencing complications were older, more likely to present with emergent PCI, recent or prior myocardial infarction, multi-vessel disease, and comorbid conditions than patients who did not experience these events. Unadjusted total costs were, on average, $27,865+/-$39,424 for complicated patient episodes compared to $12,279+/-$6796 for episodes that were complication free (p<0.0001). Adjusted mean costs were $6984 higher for complicated PCIs compared with uncomplicated PCI episodes (95% CI of cost difference: $5801, $8168). Incremental costs associated with isolated bleeding events, MACCE, or for both bleeding and MACCE events were $5883, $5086, and $15,437, respectively (p<0.0001).


CONCLUSIONS
This high-volume study highlights the significant economic burden associated with procedural complications. Resources and systems approaches to minimising clinical and economic complications in PCI are warranted.
Jacobson
Kurt M
KM
Division of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Hall Long
Kirsten
K
McMurtry
Erin K
EK
Naessens
James M
JM
Rihal
Charanjit S
CS
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000191:economics*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008910:Minnesota; D011183:Postoperative Complications / Q000191:economics*; D012042:Registries; D012307:Risk Factors