Defining value in cardiac surgery: A contemporary analysis of cost variation across the United StatesCentral MessagePerspective

Defining value in cardiac surgery: A contemporary analysis of cost variation across the United StatesCentral MessagePerspective

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Objective: Isolated coronary artery bypass grafting and aortic valve replacement are common cardiac operations performed in the United States and serve as platforms for benchmarking.The present national study characterized hospital-level variation in costs and value for coronary artery bypass carhartt flasche grafting and aortic valve replacement.Methods: Adults undergoing elective, isolated coronary artery bypass grafting or aortic valve replacement were identified in the 2016-2018 Nationwide Readmissions Database.

Center quality was defined by the proportion of patients without an adverse outcome (death, stroke, respiratory failure, pneumonia, sepsis, acute kidney injury, and reoperation).High-value hospitals were defined as those with observed-to-expected ratios less than 1 for costs and greater than 1 for quality, whereas the converse defined low-value centers.Results: Of 318,194 patients meeting study criteria, 71.

9% underwent isolated coronary artery bypass grafting and 28.1% underwent aortic valve replacement.Variation in hospital-level costs was evident, with median center-level cost of $36,400 (interquartile range, 29,500-46,700) for isolated coronary artery bypass grafting and $38,400 (interquartile range, 32,300-47,700) for aortic valve replacement.

Observed-to-expected ratios for quality ranged from 0.2 to 10.9 for isolated led cocktail smoker coronary artery bypass grafting and 0.

1 to 11.7 for isolated aortic valve replacement.Hospital factors, including volume and quality, contributed to approximately 9.

9% and 11.2% of initial cost variation for isolated coronary artery bypass grafting and aortic valve replacement.High-value centers had greater cardiac surgery operative volume and were more commonly teaching hospitals compared to low-value centers, but had similar patient risk profiles.

Conclusions: Significant variation in hospital costs, quality, and value exists for 2 common cardiac operations.Center volume was associated with value and partly accounts for variation in costs.Our findings suggest the need for value-based care paradigms to reduce expenditures and optimize outcomes.