Abstract 14210: Standardized Protocol to Optimize Management of Patients with Post-operative Atrial Fibrillation Reduces Length of Stay and Hospital Costs

Abstract

BACKGROUND: Post-operative atrial fibrillation (POAF) develops in approximately 30-40% of patients undergoing cardiovascular (CV) surgery and increases major adverse events, length of stay (LOS) and hospitalization costs. A standardized protocol may optimize POAF management and decrease LOS, hospital costs and adverse events including post-operative stroke. METHODS: In March 2013, an AF inpatient protocol was implemented in our CV surgery center’s post-operative care units. The protocol incorporates a consensus driven decision support algorithm based on blood pressure, heart rate and duration of AF to guide beta-blocker, antiarrhythmic and anticoagulation therapy recommendations in real-time. Using a shared electronic medical record we reviewed all coronary artery bypass graft (CABG) and valve surgery cases from March 1, 2013 to April 30, 2014 and compared LOS, intensive care unit (ICU) duration and post-operative stroke in POAF patients with and without the protocol. Based on actual CV surgery volume and average total variable cost per hospital day, we estimated the protocol’s impact post-implementation and at 50% annual use. RESULTS: Among 492 CABG and valve surgery cases, 176 (35.8%) developed POAF. Among patients with POAF, 55 (31.3%) used the AF protocol and 121 (68.7%) did not. In patients with POAF, median LOS was significantly shorter in cases with the protocol (6.9 [6.0, 9.1] days vs. 8.2 [6.1, 11.9] days; p=0.016). There was no difference in ICU duration or post-operative stroke (Table). Among 151 annual cases of POAF, average total variable cost was $2,374 per hospital day. Post-implementation, 71.5 hospital days and $169,741 have been saved. Achieving 50% protocol use, we estimate 98.0 hospital days and $232,652 could be saved annually. CONCLUSIONS: A standardized decision support protocol for POAF patients is associated with shorter LOS and provides a significant reduction in hospital days and total variable cost.