Practice pattern variability for myocardial revascularization: Impact on resource use across 24 centers

Joseph S. Savino, Catherine Ley, Denis Boisvert, Arnold Friedman, Joseph Mathew, Colleen Koch, Norman Starr, Christina Mora Mangano, Ahvie Herskowitz, Warren S. Browner, Dennis T. Mangano

Research output: Contribution to journalArticle

Abstract

Objective: To determine the predictors of hospital length of stay (LOS) after elective uncomplicated coronary artery bypass graft surgery. Design: Retrospective analysis of the EPI-1 database, 1991-1993. Setting: Multicenter; 24 academic, private, federal, and health maintenance institutions. Participants: Patients undergoing elective CABG surgery (n = 2,417). Measurements and Main Results: Using a systematic sampling scheme at each site, each patient was evaluated to identify markers of chronic disease, perioperative test data, treatments, adverse outcomes, and LOS. Institutional differences in the care of patients free of complications were assessed using a multivariate model. LOS was the outcome variable selected to estimate cost. A total of 861 patients (37%) were free of any complication. The mean site LOS ranged from 5.4 to 9.0 days, with half of the 24 centers reporting a hospital LOS routinely >7.1 days. The predominant factor associated with a complication-free LOS was site per se, accounting for 32% of the variability in hospital LOS that could not be explained by any site characteristic (eg, size, geographic location, academic affiliation). Multivariable analysis identified 3 demographic predictors - age >75 years (increasing LOS by 1.3 days), admission from the emergency department (increasing LOS by 0.7 days), and uninsured or Medicaid-insured (increasing LOS by 0.4 days); 2 historical predictors - New York Heart Association class III or IV congestive heart failure (increasing LOS by 0.5 days) and history of arrhythmia (increasing LOS by 0.7 days); and 2 practice patterns - transfusion of blood products (increasing LOS by 0.3 days) and delayed extubation (increasing LOS by 0.5 days). Previous myocardial infarction, diabetes, chronic obstructive pulmonary disease, neurologic disease, and other historical factors were not associated with LOS in patients without a complication. Conclusion: A substantial variability in LOS after complication-free coronary artery bypass graft surgery was determined predominantly by site per se, even after adjustment for disease severity, site type or location, and surgical and anesthetic practices. The variability in LOS was likely due to practice style influences and represents an opportunity to decrease waste in the provision of a common and expensive procedure.

Original languageEnglish (US)
Pages (from-to)149-156
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume16
Issue number2
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Myocardial Revascularization
Length of Stay
Coronary Artery Bypass
Transplants
Geographic Locations

Keywords

  • Complications
  • Coronary artery bypass graft (CABG) surgery
  • LOS
  • Practice patterns
  • Resource use

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Practice pattern variability for myocardial revascularization : Impact on resource use across 24 centers. / Savino, Joseph S.; Ley, Catherine; Boisvert, Denis; Friedman, Arnold; Mathew, Joseph; Koch, Colleen; Starr, Norman; Mangano, Christina Mora; Herskowitz, Ahvie; Browner, Warren S.; Mangano, Dennis T.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 16, No. 2, 2002, p. 149-156.

Research output: Contribution to journalArticle

Savino, JS, Ley, C, Boisvert, D, Friedman, A, Mathew, J, Koch, C, Starr, N, Mangano, CM, Herskowitz, A, Browner, WS & Mangano, DT 2002, 'Practice pattern variability for myocardial revascularization: Impact on resource use across 24 centers', Journal of Cardiothoracic and Vascular Anesthesia, vol. 16, no. 2, pp. 149-156. https://doi.org/10.1053/jcan.2002.31055
Savino, Joseph S. ; Ley, Catherine ; Boisvert, Denis ; Friedman, Arnold ; Mathew, Joseph ; Koch, Colleen ; Starr, Norman ; Mangano, Christina Mora ; Herskowitz, Ahvie ; Browner, Warren S. ; Mangano, Dennis T. / Practice pattern variability for myocardial revascularization : Impact on resource use across 24 centers. In: Journal of Cardiothoracic and Vascular Anesthesia. 2002 ; Vol. 16, No. 2. pp. 149-156.
@article{64cdb8bed6e648a582673113804a4e38,
title = "Practice pattern variability for myocardial revascularization: Impact on resource use across 24 centers",
abstract = "Objective: To determine the predictors of hospital length of stay (LOS) after elective uncomplicated coronary artery bypass graft surgery. Design: Retrospective analysis of the EPI-1 database, 1991-1993. Setting: Multicenter; 24 academic, private, federal, and health maintenance institutions. Participants: Patients undergoing elective CABG surgery (n = 2,417). Measurements and Main Results: Using a systematic sampling scheme at each site, each patient was evaluated to identify markers of chronic disease, perioperative test data, treatments, adverse outcomes, and LOS. Institutional differences in the care of patients free of complications were assessed using a multivariate model. LOS was the outcome variable selected to estimate cost. A total of 861 patients (37{\%}) were free of any complication. The mean site LOS ranged from 5.4 to 9.0 days, with half of the 24 centers reporting a hospital LOS routinely >7.1 days. The predominant factor associated with a complication-free LOS was site per se, accounting for 32{\%} of the variability in hospital LOS that could not be explained by any site characteristic (eg, size, geographic location, academic affiliation). Multivariable analysis identified 3 demographic predictors - age >75 years (increasing LOS by 1.3 days), admission from the emergency department (increasing LOS by 0.7 days), and uninsured or Medicaid-insured (increasing LOS by 0.4 days); 2 historical predictors - New York Heart Association class III or IV congestive heart failure (increasing LOS by 0.5 days) and history of arrhythmia (increasing LOS by 0.7 days); and 2 practice patterns - transfusion of blood products (increasing LOS by 0.3 days) and delayed extubation (increasing LOS by 0.5 days). Previous myocardial infarction, diabetes, chronic obstructive pulmonary disease, neurologic disease, and other historical factors were not associated with LOS in patients without a complication. Conclusion: A substantial variability in LOS after complication-free coronary artery bypass graft surgery was determined predominantly by site per se, even after adjustment for disease severity, site type or location, and surgical and anesthetic practices. The variability in LOS was likely due to practice style influences and represents an opportunity to decrease waste in the provision of a common and expensive procedure.",
keywords = "Complications, Coronary artery bypass graft (CABG) surgery, LOS, Practice patterns, Resource use",
author = "Savino, {Joseph S.} and Catherine Ley and Denis Boisvert and Arnold Friedman and Joseph Mathew and Colleen Koch and Norman Starr and Mangano, {Christina Mora} and Ahvie Herskowitz and Browner, {Warren S.} and Mangano, {Dennis T.}",
year = "2002",
doi = "10.1053/jcan.2002.31055",
language = "English (US)",
volume = "16",
pages = "149--156",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Practice pattern variability for myocardial revascularization

T2 - Impact on resource use across 24 centers

AU - Savino, Joseph S.

AU - Ley, Catherine

AU - Boisvert, Denis

AU - Friedman, Arnold

AU - Mathew, Joseph

AU - Koch, Colleen

AU - Starr, Norman

AU - Mangano, Christina Mora

AU - Herskowitz, Ahvie

AU - Browner, Warren S.

AU - Mangano, Dennis T.

PY - 2002

Y1 - 2002

N2 - Objective: To determine the predictors of hospital length of stay (LOS) after elective uncomplicated coronary artery bypass graft surgery. Design: Retrospective analysis of the EPI-1 database, 1991-1993. Setting: Multicenter; 24 academic, private, federal, and health maintenance institutions. Participants: Patients undergoing elective CABG surgery (n = 2,417). Measurements and Main Results: Using a systematic sampling scheme at each site, each patient was evaluated to identify markers of chronic disease, perioperative test data, treatments, adverse outcomes, and LOS. Institutional differences in the care of patients free of complications were assessed using a multivariate model. LOS was the outcome variable selected to estimate cost. A total of 861 patients (37%) were free of any complication. The mean site LOS ranged from 5.4 to 9.0 days, with half of the 24 centers reporting a hospital LOS routinely >7.1 days. The predominant factor associated with a complication-free LOS was site per se, accounting for 32% of the variability in hospital LOS that could not be explained by any site characteristic (eg, size, geographic location, academic affiliation). Multivariable analysis identified 3 demographic predictors - age >75 years (increasing LOS by 1.3 days), admission from the emergency department (increasing LOS by 0.7 days), and uninsured or Medicaid-insured (increasing LOS by 0.4 days); 2 historical predictors - New York Heart Association class III or IV congestive heart failure (increasing LOS by 0.5 days) and history of arrhythmia (increasing LOS by 0.7 days); and 2 practice patterns - transfusion of blood products (increasing LOS by 0.3 days) and delayed extubation (increasing LOS by 0.5 days). Previous myocardial infarction, diabetes, chronic obstructive pulmonary disease, neurologic disease, and other historical factors were not associated with LOS in patients without a complication. Conclusion: A substantial variability in LOS after complication-free coronary artery bypass graft surgery was determined predominantly by site per se, even after adjustment for disease severity, site type or location, and surgical and anesthetic practices. The variability in LOS was likely due to practice style influences and represents an opportunity to decrease waste in the provision of a common and expensive procedure.

AB - Objective: To determine the predictors of hospital length of stay (LOS) after elective uncomplicated coronary artery bypass graft surgery. Design: Retrospective analysis of the EPI-1 database, 1991-1993. Setting: Multicenter; 24 academic, private, federal, and health maintenance institutions. Participants: Patients undergoing elective CABG surgery (n = 2,417). Measurements and Main Results: Using a systematic sampling scheme at each site, each patient was evaluated to identify markers of chronic disease, perioperative test data, treatments, adverse outcomes, and LOS. Institutional differences in the care of patients free of complications were assessed using a multivariate model. LOS was the outcome variable selected to estimate cost. A total of 861 patients (37%) were free of any complication. The mean site LOS ranged from 5.4 to 9.0 days, with half of the 24 centers reporting a hospital LOS routinely >7.1 days. The predominant factor associated with a complication-free LOS was site per se, accounting for 32% of the variability in hospital LOS that could not be explained by any site characteristic (eg, size, geographic location, academic affiliation). Multivariable analysis identified 3 demographic predictors - age >75 years (increasing LOS by 1.3 days), admission from the emergency department (increasing LOS by 0.7 days), and uninsured or Medicaid-insured (increasing LOS by 0.4 days); 2 historical predictors - New York Heart Association class III or IV congestive heart failure (increasing LOS by 0.5 days) and history of arrhythmia (increasing LOS by 0.7 days); and 2 practice patterns - transfusion of blood products (increasing LOS by 0.3 days) and delayed extubation (increasing LOS by 0.5 days). Previous myocardial infarction, diabetes, chronic obstructive pulmonary disease, neurologic disease, and other historical factors were not associated with LOS in patients without a complication. Conclusion: A substantial variability in LOS after complication-free coronary artery bypass graft surgery was determined predominantly by site per se, even after adjustment for disease severity, site type or location, and surgical and anesthetic practices. The variability in LOS was likely due to practice style influences and represents an opportunity to decrease waste in the provision of a common and expensive procedure.

KW - Complications

KW - Coronary artery bypass graft (CABG) surgery

KW - LOS

KW - Practice patterns

KW - Resource use

UR - http://www.scopus.com/inward/record.url?scp=0036252165&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036252165&partnerID=8YFLogxK

U2 - 10.1053/jcan.2002.31055

DO - 10.1053/jcan.2002.31055

M3 - Article

C2 - 11957162

AN - SCOPUS:0036252165

VL - 16

SP - 149

EP - 156

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 2

ER -