. Does it really help, in patient management ,to know the cost of cardiac surgery complications and if so, what is the most expensive and the cheapest complication of cardiac surgery
I suppose it depends on the point of view that you are taking. If you are a provider getting paid fee-for-service, you may not know (or care) about the costs of complications. If you are either the insurance company or patient who ultimately pay for the costs of care (including complications stemming from surgery), you probably care quite a bit. In the US there are efforts to hold hospitals accountable for complications arising during the hospital stay. These usually take the form of reduced payment or no payment for readmission. There are also efforts to measure complications, which may be considered issues of potential poor quality of care.
It may not be of value to the individual patient (unless they are personally footing the bill), but it is crucial information needed to deliver success for your unit. Standardisation of process and pathways is well known to improve outcomes and reduce cost, and most additional costs are associated with utliers. A good head of department can drive clinical quality not just by asking for it and expecting it, but by using levers such as cost of complications to change behaviour.
take, for example, a phrenic N palsy in a child. Most units have an incidence of around 1.5% so about 15/1000 cases. Few surgeons rec9ognise the cost, and the incidence is low, so often dismissed as 'an expected complication'. However, it takes two days in ICU to diagnose, 1 day to convince the surgeon, 1 day to plicate the diaphragm, 2 ICU days to recover and at least 1 extra week in hospital. This rapidly accumulates to >50,000 $. If you ad dthe opportunity cost of what you could have done in the space and time available without the complication, the cost at least doubles to >&100,000. In our system we have a cop pon the number of bed days that the governement will pay for, so complications really hurt, and if a patient has to go back to OR unexpectedly within 30 days, it is at our expense. these are good quality drivers.
Do the same sums for wound infections, pleural effusions, line infections etc and you soon see a horrific cost.
Tell the surgeons what they cost, and quality will improve. Surgeons are VERY competetive
In our scenario we explain the cost of complication if we are anticipating it, or the case is a high risk. If the patient is well covered with insurance then we can explain as and when the need arise
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