Factors Associated with High Resource Utilization in Elective Adult Cardiac Surgery from 2005 - 2016.

Abstract Background Lack of consensus remains about factors that may be associated with high resource utilization (HRU) in adult cardiac surgical patients. We aimed to identify patient, hospital, and perioperative characteristics associated with HRU admissions involving elective cardiac operations. Methods Data from the National Inpatient Sample was used to identify patients who underwent coronary artery bypass graft (CABG), valve replacement, and valve repair operations between 2005 and 2016. Admissions with HRU were defined as those in the highest decile for total hospital costs. Multivariable regressions were used to identify factors associated with HRU. Results An estimated 1,750,253 hospitalizations coded for elective cardiac operations. The median hospitalization cost was $34.7K (IQR $26.8K - $47.1K), with HRU (N=175,025) cutoff at $66,029. Although HRU patients comprised 10% of admissions, they accounted for 25% of cumulative costs. On multivariable regression, patient characteristics predictive of HRU included female sex, older age, higher comorbidity burden, non-white race, and highest income quartile. Hospital factors associated with HRU were low volume hospitals for both CABG and valvular operations. Among postoperative outcomes, mortality, infectious complication, extracorporeal membrane oxygenation use, and hospitalization > 8 days were associated with greater odds of HRU. Conclusions In this nationwide study of elective cardiac surgical patients, several important patient and hospital factors, including patient race, comorbidities, postoperative infectious complications, and low hospital operative volume were identified as predictors of HRU. These highly predictive factors may be used for benchmarking purposes and improvement in surgical planning.