Abstract
Cirrhosis is known to adversely affect cardiac surgery outcomes. Our objective was to quantify the morbidity, mortality, and cost that cirrhosis adds to surgical aortic valve replacement. From 1998 to 2011, 423,789 patients in the Nationwide Inpatient Sample Healthcare Cost Utilization Project underwent isolated aortic valve replacement; 2,769 (0.7%) had cirrhosis. Multivariable linear regression and 1:1 propensity matching were used to determine the effect of cirrhosis on postsurgical outcomes. The number of patients with cirrhosis who underwent surgical aortic valve replacement per year more than tripled during the 13-year study period. Patients with cirrhosis were more likely to be younger (p <0.0001), insured by Medicaid (p <0.0001), and operated on at an academic or high-volume hospital (p <0.05). Risk-adjusted mortality for patients with cirrhosis was 16%, compared with 5% for patients without cirrhosis. Risk factors for death included congestive heart failure, fluid and electrolyte imbalances, pulmonary circulation disorders, and weight loss. Among propensity-matched pairs, patients with cirrhosis had a higher mortality (odds ratio [OR] 3.6), risk of any complication [OR 1.5], and acute renal failure (OR 2.2). There was no increased risk of stroke, wound infection, blood transfusion, or pneumonia. The risk-adjusted length of stay (15 vs 12 days) and cost ($68,000 vs 56,000) were higher in patients with cirrhosis. In conclusion, the presence of cirrhosis poses a significant risk of death in patients who underwent surgical aortic valve replacement. When performed, the cost and length of stay are increased compared with those without cirrhosis.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 648-654 |
| Number of pages | 7 |
| Journal | American Journal of Cardiology |
| Volume | 120 |
| Issue number | 4 |
| DOIs | |
| State | Published - Aug 15 2017 |
Funding
We analyzed the data looking at in-patient mortality, complications, cost, hospital charges, length of stay, and discharge disposition. The complications were identified using secondary ICD-9-CM codes. Hospital resource consumption use entailed an evaluation of hospitalization charges and hospitalization cost. Total charges included the amount the hospital billed but did not include professional fees. Total costs were calculated from total charges using a cost-to-charge ratio created by the Healthcare Cost and Utilization Project that is based on accounting reports from the Centers for Medicare and Medicaid Services. Hospital cost was calculated by multiplying total charges with the hospital-specific cost-to-charge ratio. Using the appropriate Consumer Price Index, costs were adjusted for inflation and converted to 2014 US dollars.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine