1019-23 Use of a Cost Outcome Risk Score to Simultaneously Stratify Mortality, Morbidity, and Cost Outcomes for Cardiac Valve Patients

Abstract

To investigate whether risks in postoperative outcomes (mortality, morbidity and costs [not charges]) can be simultaneously stratified preoperatively, data were reviewed for 551 consecutive patients who underwent valve surgery. Patient age 64.0 (± 15.4) years and 43.4% females. There were 279 (50.6%) aortic valve procedures, 177 (32.1%) mitral valve procedures. 7 (1.3%) tricuspid valve procedures, 88 (16.0%) combined valve procedures, and 150 (20.7%) valve plus coronary procedures. The average total hospital stay was 13.7 (± 14) days and postoperative stay was 11.0 (± 12.6) days. To develop a cost outcome risk score, multivariate analysis of hospital costs via the Cox proportional hazards model was applied. This model adjusts for patient's death, patients's health status at discharge and is not distorted by cost outliers. Patient age, gender, body surface area, body mass index. surgeon case-volume, procedural urgency, preoperative ejection fraction, history of diabetes, infective endocarditis, pulmonary hypertension, history of CABG, prior MI, and type of procedures were incorporated. Score N Hospital † Hasp. Total † Hasp. Cardiact † Hospital † Costs ($) Mortality Mortality Morbidity 2–6.9 72 15,571 0.00 0.00 2.78 7–11.9 137 18,414 2.92 0.73 13.14 12–17.9 120 23,040 4.17 2.50 20.00 18–27.9 97 27,906 10.31 5.15 31.96 ≥ 28 125 41,605 22.40 10.40 52.80 ALL 551 25,982 8.53 3.99 25.59 † P < 0.001 for testing differences among risk groups. Hospital costs = hospital adjusted direct costs 1) When patients are stratified for hospital costs by preoperative risk factors, the same scoring system accurately predicts mortality and morbidity outcomes. 2) Using this analysis framework. with agreed upon preoperative risk factors, cost efficiency as well as other outcomes can be compared across programs, physicians, and geographic regions.