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Post-operative atrial fibrillation (POAF) is the most frequent complication following cardiac surgery and increases length of stay (LOS) and hospital costs. The PAPABEAR trial recently demonstrated that short-term peri-operative oral amiodarone prevented atrial arrhythmias after cardiovascular surgery. Improved utilization of prophylactic therapies has the potential to reduce POAF and subsequently decrease LOS and hospital costs. This analysis was conducted to estimate the impact reducing POAF would have on LOS and hospital costs annually.
Using a shared electronic medical record we reviewed all elective coronary artery bypass graft (CABG) and valve surgery cases at three high volume centers from January 2009 to December 2011 to determine the incidence of POAF, and median LOS and total variable costs for patients with and without POAF. Based on the PAPABEAR trial, two scenarios (achieving 50% and 100% of the PAPABEAR outcomes) were modeled to determine the impact of prophylactic therapies to reduce POAF, LOS, and total variable costs.
Among 1,297 elective CABG and valve surgery cases, POAF occurred in 392 (30.2%) patients. Median LOS was 2 days longer (7 [6-9] days vs. 5 [4-7] days; p<0.001) and median total variable costs $2,495 higher ($18,370 [$14,536-$23,874] vs. $15,875 [$12,306-$20,764]; p<0.001) in POAF patients. Achieving 50% of the PAPABEAR outcomes resulted in 30 fewer POAF cases, 58.4 days less in LOS, and $121,422 less in total variable cost annually. Achieving 100% of the PAPABEAR outcomes resulted in 60 fewer POAF cases, 113.1 days less in LOS, and $233,753 less in total variable cost annually.
POAF is frequent and associated with significantly higher LOS and hospital costs. Improved utilization of prophylactic therapies has the potential to lower the incidence of POAF in elective CABG and valve surgery patients, and thereby reduce LOS and total variable costs. These results illustrate the rationale and potential opportunity for implementation of standardized pre-operative therapies to reduce POAF.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmia Outcomes and Quality Assessment
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1245-110
- 2013 American College of Cardiology Foundation