Abstract
Introduction: The cost of care for surgical complications such as sepsis is increasing over time at a rate exceeding inflation. Postoperative myocardial infarction (POMI) is a major surgical complication associated with not only significant mortality, but a significant increase in costs of care. Diagnosis and treatment of POMI has improved over time, however, the economic impact of these new treatments has not been fully explored. Hypothesis: We hypothesized that similar to post-operative sepsis, the cost of care for POMI is increasing faster than the rate of inflation. Methods: Approximately 28 million inpatient discharges were analyzed between 2003 and 2009 from the California State Inpatient Database. POMI was defined using ICD-9-CM codes. Propensity matching was used, adjusted for potential confounding in 17,414 matched pairs. A quantile regression model was used with incremental charges as the response variable and year of discharge as the main predictor to evaluate the incremental charges over time. Model based Wald test were used to perform the tests of trends over time. All charges were adjusted to a base year of 2012 using the medical component of the consumer price index. Results: Results showed that the Wald test of linear trend over time for the median incremental charges was not significant. The median incremental charges changed annually by -$1430 (95% CI; -$2880, +$20). The bottom 10% of charges did not significantly change with time. However, the highest 10% of charges did significantly change with an annual decrease of -$7080 (-$12,510, -$1660). Compared to control patients, the median incremental length of stay associated with POMI was significantly decreasing over time as well as the 90th percentile. The 10th percentile showed no significant change over time. No differences in mortality were seen, however POMI patients became increasingly more likely to be transferred to another facility. Conclusions: During the 2003-09-time period, median incremental economic charges for POMI did not outpace inflation, potentially benefiting from factors influencing length of stay.
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