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Open Access Research article

Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients

Akmal MA Badreldin1, Fabian Doerr2, Axel Kroener3, Thorsten Wahlers3 and Khosro Hekmat3*

Author Affiliations

1 Department of Aneasthesia and Operative Intensive Care Medicine, University of Bonn, Sigmund-Freud-Street 25, Bonn 53127, Germany

2 School of Medicine, Friedrich-Schiller-University of Jena, Bachstraße 18, Jena 07743, Germany

3 Department of Cardiothoracic Surgery, University of Cologne, Kerpenerstraße 62, Cologne 50937, Germany

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Journal of Cardiothoracic Surgery 2013, 8:126  doi:10.1186/1749-8090-8-126

Published: 9 May 2013

Abstract

Background

Preoperative risk stratification models have previously been suggested to predict cardiac surgery unit costs. However, there is a lack of consistency in their reliability in this field. In this study we aim to test the correlation between the values of six commonly known preoperative scoring systems and evaluate their reliability at predicting unit costs of cardiac surgery patients.

Methods

Over a period of 14 months all consecutive adult patients undergoing cardiac surgery on cardiopulmonary bypass were prospectively classified using six preoperative scoring models (EuroSCORE, Parsonnet, Ontario, French, Pons and CABDEAL). Transplantation patients were the only patients we excluded. Total hospital costs for each patient were calculated independently on a daily basis using the bottom up method. The full unit costs were calculated including preoperative diagnostic tests, operating room cost, disposable materials, drugs, blood components as well as costs for personnel and fixed hospital costs. The correlation between hospital cost and the six models was determined by linear regression analysis. Both Spearman’s and Pearson’s correlation coefficients were calculated from the regression lines. An analysis of residuals was performed to determine the quality of the regression.

Results

A total of 887 patients were operated on for CABG (n = 608), valve (n = 142), CABG plus valve (n = 100), thoracic aorta (n = 33) and ventricular assist devices (n = 4). Mean age of the patients was 68.3±9.9 years, 27.6% were female. 30-day mortality rate was 4.1%. Correlation between the six models and hospital cost was weak (Pearson’s: r < 0.30; Spearman’s: r < 0.40).

Conclusion

The risk stratification models in this study are not reliable at predicting total costs of cardiac surgical patients. We therefore do not recommend their use for this purpose.

Keywords:
Hospital cost; Cardiac surgery; Scoring models