Cost analysis of re-exploration for bleeding after coronary artery bypass graft surgery

Abstract

BackgroundRe-exploration for bleeding after cardiac surgery is an indicator of substantial haemorrhage and is associated with increased hospital resource utilization. This study aimed to analyse the costs of re-exploration and estimate the costs of haemostatic prophylaxis. MethodsA total of 4232 patients underwent isolated, first-time, coronary artery bypass graft (CABG) surgery during 20058. Each patient re-explored for bleeding (n127) was matched with two controls not requiring re-exploration (n254). Cost analysis was based on resource utilization from completion of CABG until discharge. A mean cost per patient for re-exploration was calculated. Based on this, the net cost of prophylactic treatment with haemostatic drugs for preventing re-exploration was calculated. ResultsPatients undergoing re-exploration had higher exposure to clopidogrel before operation, prolonged stays in the intensive care unit, and more blood transfusions than controls. The mean incremental cost for re-exploration was €6290 [95 confidence interval (CI) €3408€9173] per patient, of which 48 [€3001 (95 CI €249€2147)] was due to prolonged stay, 31 [€1928 (95 CI €1710€2147)] to the cost of surgery/anaesthesia, 20 [€1261 (95 CI €1145€1378)] to the increased number of blood transfusions, and <2 [€100 (95 CI €39€161)] to the cost of haemostatic drugs. A cost model, at an estimated 50 efficacy for recombinant activated clotting factor VIIa and a 50 expected risk for re-exploration without prophylaxis, demonstrated that to be cost neutral, prophylaxis of four patients needed to result in one avoided re-exploration. ConclusionsThe resource utilization costs were substantially higher in patients requiring re-exploration for bleeding. From a strict cost-effectiveness perspective, clinical interventions to prevent haemorrhage might be underutilized. © The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.