IMPACT OF THE OPERATING PHYSICIAN ON COSTS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

The hospital charts and billing records of 250 consecutive admissions for percutaneous transluminal coronary angioplasty (PTCA) at a univers ity hospital were reviewed. Clinical characteristics, performing physi cian, angiographic features of the dilated lesion, procedural outcome, length of stay, and total and departmental hospital costs were record ed for each patient. We identified several independent predictors of h ospital cost, including the physician ($4,400 increase from highest- t o lowest-cost physician, p = 0.004), age ($790 Increase per 10-year in crease In age, p = 0.002), urgency of the procedure ($4,100 increase f or urgent vs elective, p < 0.001), and combined angiography and PTCA ( $850 increase vs separate angiography, p = 0.04). Independent predicto rs of catheterization laboratory cost included the physician ($1,280 i ncrease from highest- to lowest-cost physician, p = 0.03), American Co llege of Cardiology/American Heart Association lesion type B2 or C ($3 20 increase, p = 0.03), and combined angiography and PTCA ($430 increa se, p = 0.003). Expensive operators used more catheterization laborato ry resources than inexpensive operators; however, there were no signif icant differences in success rate or need for emergent bypass surgery between physicians. PTCA cost is determined by both patient characteri stics and the performing physician. The increase in cost due to the ph ysician was not explained by patient variables, lesion characteristics , success rate, or complications.