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Volume 3 Supplement 1

ESICM LIVES 2015

  • Poster presentation
  • Open Access

Readmission costs related to intensive care after cardiac surgery. analysis of risk factors and costs within six months after discharge using an administrative registry

  • 1 and
  • 2, 3
Intensive Care Medicine Experimental20153 (Suppl 1) :A65

https://doi.org/10.1186/2197-425X-3-S1-A65

  • Published:

Keywords

  • Intensive Care Unit
  • National Health Service
  • Intensive Care Unit Stay
  • Prolonged Mechanical Ventilation
  • Global Cost

Introduction

Prolonged stay in intensive care unit (ICU) after cardiac surgery may increase the long-term risk of readmission. Preoperative risk factors, surgical complications, infections and organ failure may need specific intensive support, increasing costs of reimbursement mainly for ICU interventions. Readmission costs over months after discharge may be a dependant of the need of intensive care.

Objectives

We analyzed the impact of ICU interventions and patients´ conditions on readmission risk and on global costs of reimbursement from the National health service with DRG methodology and assessed the impact of ICU on global costs for complicated cardiac surgery patients.

Methods

We selected 2067 patients who were admitted to ICUs after cardiac surgery in Regione Piemonte, Italy, in 2009 and analyzed all administrative data listing diagnosis and procedures according to ICD-9CM definitions. Known risk factors for complications and surgical events were selected as ICD-9CM codes. Specific ICU procedures were included if they had impact in DRG calculation. Hospital history was followed for six months after discharge and costs of new admissions were related to selected codes and conditions at the first intervention. We used hazard models and regression analysis to identify ICD9-CM codes that are predictors of readmission and their impact on reimbursement costs, with regard to ICU events.

Results

528 out of 2067 (25,54%) patients had in total 877 readmissions. In this population hospital length of stay, tracheostomy, heart or kidney failure, infection and the use of IABP or ECMO are strong risk factors for readmission. Tracheostomy accounts for the major increase of costs as DRG consider it an indicator for extensive use of ICU resources. Shock and prolonged mechanical ventilation are inversely related to increased risk of readmission, but they require additional significant expenditure. Some negative findings on the risk of readmission may be explained with increased mortality rate in those patients. Full results are shown in Tables 1-3.
Table 1

IMPACT OF ADMISSION CONDITIONS.

 

Risk of readmission (logistic regression)

Impact on global costs (linear regression)

 

estimate (logit)

Standard Error

p value

estimate (EUR)

Standard Error

p value

Intercept

-2,416

0,35

< 0.0001

19990

1161

< 0.0001

Female gender

-0,164

0,11

0,14

-79

395

0,84

Age (per single year)

0,009

0,005

0,06

-48

17

0,004

Lenght of stay (days) base reference 0-15 days

      

15-28

0,48

0,12

< 0.0001

2170

459

< 0.0001

29-60

0,63

0,20

0,002

5017

789

< 0.0001

>60

1,1

0,41

0.007

16464

1644

< 0.0001

Rehab program

0,46

0,13

0,0005

1036

449

0,021

Table 2

IMPACT OF ICU PROCEDURES.

 

Risk of readmission (logistic regression)

Impact on global costs (linear regression)

 

estimate (logit)

Standard error

p value

estimate (EUR)

Standard error

p value

Tracheostomy

0,41

0,379

0,28

24367

1472

< 0.0001

Shock (any causes)

-0,44

0,401

0,27

3030

1344

0,02

IABP or ECMO

0,23

0,301

0,44

3318

1117

0,003

Mechanical ventilation >96 hours

-0,48

0,340

0,16

2158

1253

0,08

Dialysis

0,015

0,358

0,97

-433

1374

0,75

Table 3

IMPACT OF OTHER CLINICAL CONDITIONS.

 

Risk of readmission (logistic regression)

Impact on global costs (linear regression)

 

estimate (logit)

Standard error

p value

estimate (EUR)

Standard error

p value

Infection

0,331

0,322

0,30

-265

1235

0,83

Blood transfusion

1,06

0,321

0,0009

-2847

1292

0,03

Diabetes

0,34

0,164

0,04

-1033

616

0,09

Heart failure

0,34

0,124

0,006

1319

459

0,004

Recent myocardial ischemia

-0,131

0,130

0,32

-1817

460

< 0.0001

Respiratory disease

0,062

0,188

0,74

-634

698

0,36

Kidney disease

0,440

0,202

0,03

-484

788

0,54

Peripheral vascular disease

0,247

0,124

0,05

-1086

454

0,02

Conclusions

The need of ICU stay and procedures after cardiac surgery may significantly increase the risk of readmission and of reimbursement fee. The ICD-9CM coding system for administrative purposes might be a reliable indicator for the actual clinical risk described in existing literature and predict an increase of expenditure. Health systems should consider ICU costs in allocating resources for cardiac surgery.

Authors’ Affiliations

(1)
AO Città della Salute e della Scienza, Dipartimento di Anestesia e Rianimazione, Torino, Italy
(2)
Università di Perugia, Perugia, Italy
(3)
CAPP, Modena, Italy

References

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  3. Hannan EL, et al: 30-day readmissions after coronary artery bypass graft surgery in New York State. JACC Cardiovasc Interv. 2011, 4 (5): 569-76. 10.1016/j.jcin.2011.01.010. MayPubMedView ArticleGoogle Scholar

Copyright

© Rossi Zadra et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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