AHA: Elective PCIs cost more at hospitals with no onsite cardiac surgery

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The cost of treating patients who received elective PCI at hospitals with no onsite cardiac surgery exceeds the cost for similar care at hospitals with on-site cardiac surgery, according to a substudy of the CPORT-E trial, presented Nov. 4 as a late-breaking clinical trial at the American Heart Association (AHA) scientific sessions in Los Angeles.

At ACC.12, researchers reported that outcomes were similar for elective PCI patients treated in either hospital setting. In a continuation of the Cardiovascular Patient Outcomes Research Outcomes of Percutaneous Team (CPORT-E) clinical trial, Eric L. Eisenstein, DBA, of Duke University School of Medicine in Durham, N.C., and colleagues compared medical resource use and costs for patients treated at hospitals with and without onsite cardiac surgery.

As background, Eisenstein noted that hospitals with onsite cardiac surgery performed more PCI procedures, but fewer revascularizations at nine months while hospitals with no onsite cardiac surgery were required to use intensive care units for post-procedure care.

For their prospective economic study, Eisenstein and colleagues examined billing data from 18,273 CPORT-E patients who were treated at 59 hospitals. The primary endpoint was total medical costs at nine months and the secondary endpoint was admissions, length of stay and medical costs. Results were reported in 2011 U.S. dollars.

They found that patients treated at hospitals with onsite cardiac surgery had greater resource use, longer lengths of stay (3.73 days vs. 3.14 days for hospitals with no onsite cardiac surgery) but lower cumulative nine-month medical costs ($23,991 vs. $25,450). Researchers attributed the higher total cumulative costs for PCIs at hospitals with no onsite cardiac surgery to post-procedure ICU use (ICU room costs of $3,032 vs. $2,280 for hospitals with onsite cardiac surgery) and a higher rate of subsequent revascularizations.

In addition, total medical costs were higher in hospitals that staged 200 or less PCIs a year than at hospitals that staged more than 200 PCIs a year. Among hospitals with no onsite cardiac surgery, cumulative total medical costs averaged $24,222 at high-volume hospital vs. $25,643 at low-volume hospitals. In hospitals with onsite cardiac surgery, the totals were $23,838 and $25,365, respectively.

“These results should provide caution for hospitals without cardiac surgery back-up considering the implementation of nonprimary, or nonemergency, angioplasty services,” Eisenstein said in a release. “There is no guarantee that a community hospital can provide angioplasty services at costs comparable with those of major hospitals with onsite cardiac surgery.”