Impact of the operating physician on costs of percutaneous transluminal coronary angioplasty.
The hospital charts and billing records of 250 consecutive admissions for percutaneous transluminal coronary angioplasty (PTCA) at a university hospital were reviewed.
Clinical characteristics, performing physician, angiographic features of the dilated lesion, procedural outcome, length of stay, and total and departmental hospital costs were recorded for each patient.
We identified several independent predictors of hospital cost, including the physician ($4,400 increase from highest-to lowest-cost physician, p=0.004), age ($790 increase per 10-year increase in age, p=0.002), urgency of the procedure ($4,100 increase for urgent vs elective, p<0.001), and combined angiography and PTCA ($850 increase vs sepclrate angiography, p=0.04).
Independent predictors of catheterization laboratory cost included the physician ($1,280 increase from highest-to lowest-cost physician, p=0.03), American College of Cardiology/American Heart Association lesion type B2 or C ($320 increase, p=0.03), and combined angiography and PTCA ($430 increase, p=0.003).
Expensive operators used more catheterization laboratory resources than inexpensive operators ; however, there were no significant differences in success rate or need for emergent bypass surgery between physicians.
PTCA cost is determined by both patient characteristics and the performing physician.
The increase in cost due to the physician was not explained by patient variables, lesion characteristics, success rate, or complications.
Mots-clés Pascal : Dilatation instrumentale, Artère coronaire, Voie percutanée, Coût, Economie santé, Traitement, Homme, Traitement instrumental
Mots-clés Pascal anglais : Instrumental dilatation, Coronary artery, Percutaneous route, Costs, Health economy, Treatment, Human, Instrumentation therapy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0316770
Code Inist : 002B26E. Création : 10/04/1997.