Impact of complications of myocardial revascularization surgery on expenses during Hospital Stay / Impacto das complicações da cirurgia de revascularização do miocárdio nas despesas durante internação hospitalar

Background: Coronary artery bypass grafting (CABG) is an important treatment option for obstructive coronary artery disease, but it represents a high expense for paying sources.The complications of CABG impose an additional expense to the procedure that is not yet clearly established. Objective: To determine the economic impact of postoperative complications of CABG during hospitalization in a hospital of the unified health system (SUS). Methods: This is an observational study involving 240 patients undergoing isolated CABG in a reference hospital in cardiology in 2013. Patients aged over 30 years with proven coronary artery disease and indication to perform CRVM were included. Patients who performed CRVM associated with other procedures were excluded. Results: The average cost of hospitalization was R$ 22,647.24 (SD = R$ 28,105.66). In 97 patients who presented some complication the average cost was R$ 35,400.28 (SD = R$ 40,509.47), and in the 143 patients without complications the average cost was R$ 13,996.57 (SD = R$ 5,800.61) (p < 0.001). Expenditures ranged from R$ 17,344.37 in patients with one complication up to R$ 104,596.52 in patients with five complications (p < 0.001). Conclusions: The occurrence of complications during hospitalization for CABG dignificantly increases the costs of the procedure, but the magnitude of this increase depends on the type of complication developed, and higher expenses related to cardiovascular complications, infections and bleeding. With this information, managers can improve the allocation of resources to health

Impacto dos fatores de risco para doença arterial coronatriana nos gastos hospitalares dos pacientes submetidos à cirurgia de revascularização do miocárdio no SUS / Impact of risk factors for coronary artery disease on hospital costs of patients undergoing myocardial revascularization surgery in the Brazilian Unified Health System (SUS)

Background: Cardiovascular diseases are a major cause of mortality and morbidity. Myocardial revascularization surgery may be indicated for the relief of symptoms and to reduce mortality. However, surgery is a costly procedure and the impact of the number of cardiovascular risk factors on the cost of the procedure has not been established. Objectives: To identify the impact of risk factors for coronary artery disease on myocardial revascularization surgery cost. Methods: We selected 239 patients undergoing myocardial revascularization surgery at the National Institute of Cardiology in the period from 01 January to 31 December 2013. We included patients aged over 30 years, with indication for the procedure. Patients undergoing combined procedures were excluded. Results: Seven patients had only one risk factor, 32 patients had two risk factors, 75 patients had 3 risk factors, 78 patients had four risk factors, 36 patients had 5 risk factors and 11 patients presented 6 risk factors. The total costs, on average, was R$ 14,143.22 in the group with 1 risk factor, R$ 18,380.40 in the group with 2 risk factors, R$ 21,229.51 in the group with 3 risk factors, R$ 24,620.86 in the group with 4 risk factors, R$ 21,337.92 in the group with 5 risk factors and R$ 36,098,35 in the group with 6 risk factors (p = 0.441). Conclusion: This study demonstrates that, in a public referral center for highly complex cardiology procedures, there was no significant correlation between the number of cardiovascular risk factors and hospitalization costs

Fundamentos: As doenças cardiovasculares representam uma importante causa de mortalidade e morbidade. A cirurgia de revascularização do miocárdio pode ser indicada para o alívio dos sintomas e para diminuir a mortalidade. Entretanto, a cirurgia é um procedimento de custo elevado e não está estabelecido o impacto do número de fatores de risco cardiovasculares nos gastos do procedimento. Objetivos: Identificar o impacto dos fatores de risco para a doença arterial coronariana nos gastos com a cirurgia de revascularização do miocárdio. Métodos: Foram selecionados 239 pacientes submetidos à cirurgia de revascularização do miocárdio isolada no Instituto Nacional de Cardiologia no período entre 01 de Janeiro a 31 de Dezembro de 2013. Foram incluídos pacientes com idade superior a 30 anos e indicação de revascularização cirúrgica do miocárdio. Foram excluídos os pacientes submetidos a procedimentos combinados. Resultados: Sete pacientes apresentaram apenas 1 fator de risco, 32 pacientes apresentaram 2 fatores de risco, 75 pacientes apresentaram 3 fatores de risco, 78 pacientes apresentaram 4 fatores de risco, 36 pacientes apresentaram 5 fatores de risco e 11 pacientes apresentaram 6 fatores de risco. O total dos gastos, em média, foi de R$ 14 143,22 no grupo com 1 fator de risco, R$ 18 380,40 no grupo com 2 fatores de risco, R$ 21 229,51 no grupo com 3 fatores de risco, R$ 24 620,86 no grupo com 4 fatores de risco, R$ 21 337,92 no grupo com 5 fatores de risco e R$ 36 098,35 no grupo com 6 fatores de risco (p = 0,441). Conclusão: Este trabalho demonstra que, em uma unidade pública de referência para a realização de procedimentos cardiológicos de alta complexidade, não houve uma correlação significativa entre o número de fatores de risco cardiovascular e os custos da internação