TY - JOUR
T1 - Effect of clinical factors on length of stay after coronary artery bypass surgery
T2 - Results of the cooperative cardiovascular project
AU - Rosen, A. B.
AU - Humphries, J. O.
AU - Muhlbaier, L. H.
AU - Kiefe, C. I.
AU - Kresowik, T.
AU - Peterson, E. D.
N1 - Funding Information:
Supported in part by grant # HS 06503-03 Supplement 2 from the Health Care Financing Administration through the Agency for Health Care Policy and Research.
PY - 1999
Y1 - 1999
N2 - Background: Rising health care costs have prompted careful review of comparative hospital resource use. Length of stay after bypass surgery has received particular attention. However, many providers assert that these variations are caused by differences in the clinical mix of patients treated. Our goals were to identify the major clinical predictors of postoperative length of stay (PLOS) after coronary artery bypass graft surgery (CABG), document variations in PLOS among 28 hospitals, and assess the degree to which patient characteristics account for hospital variations in PLOS. Methods: Detailed clinical data on 3605 Medicare patients undergoing CABG in 28 Alabama and Iowa hospitals were analyzed by stepwise linear regression to identify significant clinical predictors of PLOS. Analysis of variance was used to compare hospitals' PLOS while controlling for significant patient risk factors. Results: The mean age was 72.1 years, 34.7% were female, and the inhospital mortality rate was 5.6%. The median and mean PLOS were 8 and 11.1 days, respectively. Significant predictors of longer PLOS included increasing age, female sex, history of chronic obstructive pulmonary disease, cerebrovascular disease, or mitral valve disease, elevated admission blood urea nitrogen, and preoperative placement of an intraaortic balloon pump. Hospitals varied significantly (P = .0001) in their unadjusted PLOS. These hospital-level variations persisted despite adjustment for both preoperative patient characteristics (P = .0001) and postoperative complications and death (P = .0001). Conclusions: This study found significant between-hospital variations in PLOS that were not explained by patient factors. This finding suggests the potential for increased efficiency in the care of patients undergoing CABG at many institutions. Further research is needed to determine the practice patterns contributing to variations in length of stay after bypass surgery.
AB - Background: Rising health care costs have prompted careful review of comparative hospital resource use. Length of stay after bypass surgery has received particular attention. However, many providers assert that these variations are caused by differences in the clinical mix of patients treated. Our goals were to identify the major clinical predictors of postoperative length of stay (PLOS) after coronary artery bypass graft surgery (CABG), document variations in PLOS among 28 hospitals, and assess the degree to which patient characteristics account for hospital variations in PLOS. Methods: Detailed clinical data on 3605 Medicare patients undergoing CABG in 28 Alabama and Iowa hospitals were analyzed by stepwise linear regression to identify significant clinical predictors of PLOS. Analysis of variance was used to compare hospitals' PLOS while controlling for significant patient risk factors. Results: The mean age was 72.1 years, 34.7% were female, and the inhospital mortality rate was 5.6%. The median and mean PLOS were 8 and 11.1 days, respectively. Significant predictors of longer PLOS included increasing age, female sex, history of chronic obstructive pulmonary disease, cerebrovascular disease, or mitral valve disease, elevated admission blood urea nitrogen, and preoperative placement of an intraaortic balloon pump. Hospitals varied significantly (P = .0001) in their unadjusted PLOS. These hospital-level variations persisted despite adjustment for both preoperative patient characteristics (P = .0001) and postoperative complications and death (P = .0001). Conclusions: This study found significant between-hospital variations in PLOS that were not explained by patient factors. This finding suggests the potential for increased efficiency in the care of patients undergoing CABG at many institutions. Further research is needed to determine the practice patterns contributing to variations in length of stay after bypass surgery.
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U2 - 10.1016/S0002-8703(99)70249-8
DO - 10.1016/S0002-8703(99)70249-8
M3 - Article
C2 - 10385767
AN - SCOPUS:0032772573
SN - 0002-8703
VL - 138
SP - 69
EP - 77
JO - American heart journal
JF - American heart journal
IS - 1 I
ER -