Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul;121(1):36-45.
doi: 10.1097/ALN.0000000000000233.

Economic trends from 2003 to 2010 for perioperative myocardial infarction: a retrospective, cohort study

Belinda L Udeh  1 , Jarrod E Dalton, J Steven Hata, Chiedozie I Udeh, Daniel I Sessler
Affiliations

Economic trends from 2003 to 2010 for perioperative myocardial infarction: a retrospective, cohort study

Belinda L Udeh et al. Anesthesiology. 2014 Jul.

Abstract

Background: Perioperative myocardial infarction (PMI) is a major surgical complication that is costly and causes much morbidity and mortality. Diagnosis and treatment of PMIs have evolved over time. Many treatments are expensive but may reduce ancillary expenses including the duration of hospital stay. The time-dependent economic impact of novel treatments for PMI remains unexplored. The authors thus evaluated absolute and incremental costs of PMI over time and discharge patterns.

Methods: Approximately 31 million inpatient discharges were analyzed between 2003 and 2010 from the California State Inpatient Database. PMI was defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Propensity matching generated 21,637 pairs of comparable patients. Quantile regression modeled incremental charges as the response variable and year of discharge as the main predictor. Time trends of incremental charges adjusted to 2012 dollars, mortality, and discharge destination was evaluated.

Results: Median incremental charges decreased annually by $1,940 (95% CI, $620 to $3,250); P < 0.001. Compared with non-PMI patients, the median length of stay of patients who experienced PMI decreased significantly over time: yearly decrease was 0.16 (0.10 to 0.23) days; P < 0.001. No mortality differences were seen; but over time, PMI patients were increasingly likely to be transferred to another facility.

Conclusions: Reduced incremental cost and unchanged mortality may reflect improving efficiency in the standard management of PMI. An increasing fraction of discharges to skilled nursing facilities seems likely a result from hospitals striving to reduce readmissions. It remains unclear whether this trend represents a transfer of cost and risk or improves patient care.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests

Figures

Figure 1
Figure 1
Study flow diagram. PMI = perioperative myocardial infarction
Figure 2
Figure 2
Quantiles of adjusted hospital charges versus year of discharge. Charges adjusted to 2012 values using the Bureau of Labor Statistics’ Consumer Price Index* for health care. PMI = perioperative myocardial infarction; USD = United States Dollars. *Division of Consumer Prices and Price Indexes. August 2012. Bureau of Labor Statistics, Washington, DC. www.bls.gov/CPI/cpifact4.htm. (Accessed August 12, 2013)
Figure 3
Figure 3
Quantiles of incremental hospital charges versus year of discharge. Charges adjusted to 2012 values using the Bureau of Labor Statistics’ Consumer Price Index* for health care. Incremental charges were defined as the difference in charges among each respective matched PMI/healthy pair. Matches were based on the factors listed in table 1 and restricted to those with common primary diagnosis, primary procedure, and year/quarter of treatment. PMI = perioperative myocardial infarction; USD = United States Dollars *Division of Consumer Prices and Price Indexes. August 2012. Bureau of Labor Statistics, Washington, DC. www.bls.gov/CPI/cpifact4.htm. (Accessed August 12, 2013)
Figure 4
Figure 4
Probability of discharge to various destinations as a function of year of discharge, separately for PMI and healthy patients. Probabilities all were estimated from a multinomial logistic regression model. Note that routine discharge includes those who left against medical advice and those who were alive but had an unknown destination. Note also that in the figure, home health care discharges were denoted by ‘HHC’. PMI = perioperative myocardial infarction
Figure 5
Figure 5
Odds ratios for discharge to four different destinations, comparing patients with PMI to patients without PMI. Odds ratios all were estimated from a multinomial logistic regression model. Note that routine discharge includes those who left against medical advice and those who were alive but had an unknown destination. PMI = perioperative myocardial infarction.
Figure 6
Figure 6
Quantiles of adjusted daily hospital charges versus year of discharge. Charges adjusted to 2012 values using the Bureau of Labor Statistics’ Consumer Price Index* for health care. PMI = perioperative myocardial infarction; USD = United States Dollars. *Division of Consumer Prices and Price Indexes. August 2012. Bureau of Labor Statistics, Washington, DC. www.bls.gov/CPI/cpifact4.htm. (Accessed August 12, 2013)
Figure 7
Figure 7
Quantiles of incremental daily hospital charges versus year of discharge. Charges adjusted to 2012 values using the Bureau of Labor Statistics’ Consumer Price Index *for health care. Incremental daily charges were defined as the difference in daily charges among each respective matched PMI/healthy pair. PMI = perioperative myocardial infarction; USD = United States Dollars. *Division of Consumer Prices and Price Indexes. August 2012. Bureau of Labor Statistics, Washington, DC. www.bls.gov/CPI/cpifact4.htm. (Accessed August 12, 2013)
Figure 8
Figure 8
Quantiles of length of stay versus year of discharge. PMI = perioperative myocardial infarction.
Figure 9
Figure 9
Quantiles of incremental length of stay versus year of discharge. Incremental length of stay was defined as the difference in length of stay among each respective matched PMI/healthy pair. PMI = perioperative myocardial infarction; LOS = length of stay.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA. An estimation of the global volume of surgery: A modelling strategy based on available data. Lancet. 2008;372:139–44. - PubMed
    1. Landesberg G, Beattie WS, Mosseri M, Jaffe AS, Alpert JS. Perioperative myocardial infarction. Circulation. 2009;119:2936–44. - PubMed
    1. Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Devereaux PJ, Chan MTV, Alonso-Coello P, Walsh M, Berwanger O, Villar JC, Wang CY, Garutti RI, Jacka MJ, Sigamani A, Srinathan S, Biccard BM, Chow CK, Abraham V, Tiboni M, Pettit S, Szczeklik W, Buse GL, Botto F, Guyatt G, Heels-Ansdell D, Sessler DI, Thorlund K, Garg AX, Mrkobrada M, Thomas S, Rodseth RN, Pearse RM, Thabane L, McQueen MJ, VanHelder T, Bhandari M, Bosch J, Kurz A, Polanczyk C, Malaga G, Nagele P, Le Manach Y, Leuwer M, Yusuf S. Association between postoperative Troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012;307:2295–304. - PubMed
    1. Chen JC, Kaul P, Levy JH, Haverich A, Menasche P, Smith PK, Carrier M, Verrier ED, Van de Werf F, Burge R, Finnegan P, Mark DB, Sheman SK PRIMO-CABG Investigators. Myocardial infarction following coronary artery bypass graft surgery increases healthcare resource utilization. Crit Care Med. 2007;35:1296–301. - PubMed
    1. Mangano DT. Perioperative cardiac morbidity. Anesthesiology. 1990;72:153–84. - PubMed

Publication types

MeSH terms