COST REDUCTION BY COMBINED CAROTID ENDARTERECTOMY AND CORONARY-ARTERYBYPASS-GRAFTING

Citation
Po. Daily et al., COST REDUCTION BY COMBINED CAROTID ENDARTERECTOMY AND CORONARY-ARTERYBYPASS-GRAFTING, Journal of thoracic and cardiovascular surgery, 111(6), 1996, pp. 1185-1192
Citations number
56
Categorie Soggetti
Respiratory System","Cardiac & Cardiovascular System",Surgery
ISSN journal
00225223
Volume
111
Issue
6
Year of publication
1996
Pages
1185 - 1192
Database
ISI
SICI code
0022-5223(1996)111:6<1185:CRBCCE>2.0.ZU;2-G
Abstract
A significant cost reduction is likely if patients who require coronar y artery bypass grafting with significant carotid stenosis have simult aneous carotid endarterectomy and bypass grafting, provided risk is no t increased. To investigate this issue, we retrospectively identified cases from February 1977 to May 1994 with first-time isolated carotid endarterectomy, coronary bypass, or combined procedures. In the isolat ed carotid endarterectomy population, median age was 69 years and 58% (85/146) were male, as compared with 68 years and 68% (68/100) male in the combined group; median age of the coronary bypass cohort was 65 y ears and 76% (381/500) male. A significantly higher percentage of pati ents in the coronary bypass versus combined group were in New York Hea rt Association functional class IV. In the combined group there was a significantly higher incidence of older age, diabetes, hypertension, h yperlipidemia, renal failure, and congestive heart failure. There was no difference among the three groups with respect to hospital mortalit y (0%, 3.4%, and 4.0%, respectively) and permanent stroke (0.7%, 1.2%, and 0%, respectively). Hospital costs were $4,896, $10,959 and $11,08 9, respectively, with a savings of $4,766 (30%), and Medicare hospital reimbursement was $8,575, $23,071, and $23,071, respectively, with a savings of $10,077 (25.3%). Thus, in appropriate patients, a combined procedure is cost effective, eliminating a second surgical procedure a nd the cost of the postoperative stay (3.7 +/- 2.4 days) associated wi th isolated carotid endarterectomy. Risk of permanent stroke or death is not increased.