Venous Thromboembolism After Coronary Artery Bypass Increases Health Care Costs: A Propensity Score-Matched Analysis.

Abstract

Venous thromboembolism (VTE) after cardiac surgery is rare but may increase hospital resource utilization. We sought to determine the cost associated with development of VTE in patients undergoing isolated coronary artery bypass grafting (CABG). The Society of Thoracic Surgeons data were identified for all patients undergoing isolated CABG between 2010 and 2020. VTE was defined as any deep venous thrombosis or pulmonary embolism occurring in-hospital during the index operation. Patients were propensity score matched by optimal full matching with threshold standard mean difference between -0.1 and 0.1. Cost analysis was performed on matched groups with a weighted linear regression model. A marginal effects analysis was used to determine total hospital costs. We analyzed 18,159 patients, including 162 (0.9%) in whom VTE developed. Weighted linear regression found that VTE increased total index hospitalization cost by an average of $23,150 (P < .001), driven mostly by increases in intensive care unit expenditure ($12,640), pharmacy costs ($4649), and then step-down unit costs ($1719). The average inpatient hospital cost for a patient with VTE was $57,577 compared with $34,010 for those without VTE. This increased per-patient cost equated to approximately $3.8 million more for all patients with VTE after CABG during the study period. Development of VTE after isolated CABG is associated with a significant increase in health care resource utilization driven by increased intensive care unit, pharmacy, and step-down unit costs. Centers without appropriate prophylaxis protocols should consider implementing one to best prevent this increase in resource utilization from development of this complication.