Abstract
Myocardial infarction is a considerable burden on public health. However, there is a lack of information about its economic impact on both the individual and national levels. This study aims to estimate the incremental cost, readmission risk, and length of hospital stay due to myocardial infarction as a post-operative complication. We used data from a standardized national system managed by the Vietnam Social Insurance database. The original sample size was 1,241,893 surgical patients who had undergone one of seven types of surgery. A propensity score matching method was applied to create a matched sample for cost analysis. A generalized linear model was used to estimate direct treatment costs, the length of stay, and the effect of the complication on the readmission of surgical patients. Myocardial infarction occurs most frequently after vascular surgery. Patients with a myocardial infarction complication were more likely to experience readmission within 30 and 90 days, with an OR of 3.45 (95%CI: 2.92–4.08) and 4.39 (95%CI: 3.78–5.10), respectively. The increments of total costs at 30 and 90 days due to post-operative myocardial infarction were 4,490.9 USD (95%CI: 3882.3–5099.5) and 4,724.6 USD (95%CI: 4111.5–5337.8) per case, while the increases in length of stay were 4.9 (95%CI: 3.6–6.2) and 5.7 (95%CI: 4.2–7.2) per case, respectively. Perioperative myocardial infarction contributes significantly to medical costs for the individual and the national economy. Patients with perioperative myocardial infarction are more likely to be readmitted and face a longer treatment duration.
Highlights
Myocardial infarction (MI) is a common cause of coronary artery disease (CAD) and is a cause of quality-of-life decline and in-hospital mortality [1]
In the matched sample for costs analysis, 764 patients with Perioperative myocardial infarction (PMI) were matched with 764 patients without PMI
The incidence of PMI was highest with vascular surgery (2.30%), followed by cardiothoracic surgeries (0.38%)
Summary
Myocardial infarction (MI) is a common cause of coronary artery disease (CAD) and is a cause of quality-of-life decline and in-hospital mortality [1]. Perioperative myocardial infarction (PMI) occurs most frequently within 1–3 days of surgery, with 57.4% reported 1 day after surgery and nearly 20% more by the third day [8, 9]. The mortality rate for PMI is on a downward trend [10, 11], in-hospital numbers was 11.6% among patients who are 45 years old or older in 2011 and reached 75.6% over the period 2003–2015 [12, 13]. Dennis et al recorded a rate of 30-day post-discharge mortality at 4.4% among patients who are 65 years old or older in 2017 [10]. Alongside the risk of immediate onset, PMI might occur asymptomatically, and so close post-operative follow-up and periodical clinical evaluation is needed
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