Interhospital variation in Medicare spending for infections after coronary artery bypass grafting and surgical aortic valve replacement.
Infections following cardiac surgery are common and associated with increased complications and spending. While 1 in 5 beneficiaries experience a postoperative infection within 180 days, rates vary by 40% in absolute terms across hospitals. Efforts to reduce healthcare expenditures would benefit from associating interhospital variability in infection rates with Medicare spending.
A total of 6439 coronary artery bypass grafting and/or surgical aortic valve replacement procedures between 2017 and 2022 across 33 hospitals in Michigan were evaluated using a clinical and administrative dataset. The primary outcome was overall and component inflation-adjusted spending within 180 days after surgery. Spending was compared across risk-adjusted terciles of hospital infection rates and phase of care.
The mean age (SD) of the cohort was 71.2 (7.7) years, with 29.1% female patients and 4.8% black patients. The mean adjusted infection rates across the low versus high terciles were 13.2% (2.3%) and 26.7% (6.5%) (P < .0001). Beneficiaries at low versus high infection tercile hospitals had more chronic lung disease, were more likely to undergo combined procedures and experienced longer cardiopulmonary bypass times. Overall mean (SD) spending was $72,956 ($39,875). Spending was 6.0% ($4306) lower on average at low infection rate versus high infection rate hospitals. The postindex hospitalization phase of care accounted for 19.3% of total 180-day spending but varied across hospital terciles (low, 15.9%; high, 24.5%). Infections increased 180-day spending on average by $37,207 ($102,351 vs $65,144).
Spending following cardiac surgery varies across hospital risk-adjusted infection rate terciles. Infection prevention interventions could enhance cardiac surgical value.
A total of 6439 coronary artery bypass grafting and/or surgical aortic valve replacement procedures between 2017 and 2022 across 33 hospitals in Michigan were evaluated using a clinical and administrative dataset. The primary outcome was overall and component inflation-adjusted spending within 180 days after surgery. Spending was compared across risk-adjusted terciles of hospital infection rates and phase of care.
The mean age (SD) of the cohort was 71.2 (7.7) years, with 29.1% female patients and 4.8% black patients. The mean adjusted infection rates across the low versus high terciles were 13.2% (2.3%) and 26.7% (6.5%) (P < .0001). Beneficiaries at low versus high infection tercile hospitals had more chronic lung disease, were more likely to undergo combined procedures and experienced longer cardiopulmonary bypass times. Overall mean (SD) spending was $72,956 ($39,875). Spending was 6.0% ($4306) lower on average at low infection rate versus high infection rate hospitals. The postindex hospitalization phase of care accounted for 19.3% of total 180-day spending but varied across hospital terciles (low, 15.9%; high, 24.5%). Infections increased 180-day spending on average by $37,207 ($102,351 vs $65,144).
Spending following cardiac surgery varies across hospital risk-adjusted infection rate terciles. Infection prevention interventions could enhance cardiac surgical value.
Authors
Pegues Pegues, Kazaleh Kazaleh, Hider Hider, Chang Chang, Fawaz Fawaz, Kimfon Kimfon, Alnajjar Alnajjar, Zhou Zhou, Hawkins Hawkins, DeLucia DeLucia, Schwartz Schwartz, Thompson Thompson, Braun Braun, Barnes Barnes, Pagani Pagani, Likosky Likosky,
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