Clinical and economic effects of pulmonary artery catheterization in nonemergent coronary artery bypass graft surgery

Objective: To examine the association between use of pulmonary artery cathe terization with hospital outcomes and costs in nonemergent coronary artery bypass graft (CABG) surgery. Design: Retrospective cohort study. Setting: Fifty-six community-based hospitals in 26 states. Participants: A total of 13,907 patients undergoing nonemergent CABG surger y between January 1, 1997, and December 31,1997. Measurements and Main Results: Discharge abstracts for each patient were ex amined. Stratified and multivariate analyses were used to assess the impact of pulmonary artery catheters (PACs) on in-hospital mortality, length of s tay in the intensive care unit, total length of stay, and hospital costs. O utcomes were adjusted for patient demographic factors, hospital characteris tics, and hospital volume of PAC use in the year of analysis. Fifty-eight p ercent of the patients received a PAC. After adjustment, the relative risk of in-hospital mortality was 2.10 for the PAC group compared with the patie nts who did not receive a PAC (95% confidence interval [Cl], 1.40 to 3.14; p < 0.001). The mortality risk was significantly higher in hospitals with t he lowest third of PAC use (odds ratio, 3.35; 95% Cl, 1.74 to 6.47; p < 0.0 01) and not significantly increased in the highest two thirds of users (odd s ratio, 1.62; 95% Cl, 0.99 to 2.66; p = 0.09). Days spent in critical care were similar; however, total length of hospital stay was 0.26 days longer in the PAC group (p < 0.001). Hospital costs were $1,402 higher in the PAC group. Conclusion: In the setting of nonemergent CABG surgery, pulmonary artery ca theterization was associated with an increased risk of in-hospital mortalit y, greater length of stay, and higher total costs, particularly in hospital s with low volume of PAC use. Copyright (C) 2000 by W.B. Saunders Company.