• Rawn Salenger, Eric W Etchill, Clifford E Fonner, Diane Alejo, Thomas L Matthew, WhitmanGlenn J RGJRDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., Stefano Schena, James S Gammie, Bradley Taylor, Thomas S Metkus, Sari D Holmes, Niv Ad, and Maryland Cardiac Surgery Quality Initiative.
• Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md; Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md. Electronic address: rawnsalenger@umm.edu.
• J. Thorac. Cardiovasc. Surg. 2023 Feb 1; 165 (2): 764772.e2764-772.e2.

ObjectiveCoronary artery bypass grafting is associated with significant interhospital variability in charges. Drivers of hospital charge variability remain elusive. We identified modifiable factors associated with statewide interhospital variability in hospital charges for coronary artery bypass grafting.MethodsCharge data were used as a surrogate for cost. Society of Thoracic Surgeons data from Maryland institutions and charge data from the Maryland Health Care Commission were linked to characterize interhospital charge variability for coronary artery bypass grafting. Multivariable linear regression was used to identify perioperative factors independently related to coronary artery bypass grafting charges. Of the factors independently associated with charges, we analyzed which factors varied between hospitals.ResultsA total of 10,337 patients underwent isolated coronary artery bypass grafting at 9 Maryland hospitals from 2012 to 2016, of whom 7532 patients were available for analyses. Mean normalized charges for isolated coronary artery bypass grafting varied significantly among hospitals, ranging from $30,000 to $57,000 (P < .001). Longer preoperative length of stay, operating room time, and major postoperative morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection were associated with greater hospital charges. Incidence of major postoperative events, except stroke and deep sternal wound infection, was variable between hospitals. In a univariate linear regression model, patient risk profile only accounted for approximately 10% of statistical variance in charges.ConclusionsThere is significant charge variability for coronary artery bypass grafting among hospitals within the same state. By targeting variation in preoperative length of stay, operating room time, postoperative renal failure, prolonged ventilation, and reoperation, cardiac surgery programs can realize cost savings while improving quality of care for this resource-intense patient population.Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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