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J Thorac Cardiovasc Surg 1996;111:1185-1193
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

COST REDUCTION BY COMBINED CAROTID ENDARTERECTOMY AND CORONARY ARTERY BYPASS GRAFTING

Received for publication June 21, 1995 Revisions requested Nov. 25, 1995; revisions received Feb. 14, 1996 Accepted for publication March 1, 1996 Address for reprints: Pat O. Daily, MD, 8010 Frost St., Suite 501, San Diego, CA 92123.

Abstract

A significant cost reduction is likely if patients who require coronary artery bypass grafting with significant carotid stenosis have simultaneous carotid endarterectomy and bypass grafting, provided risk is not increased. To investigate this issue, we retrospectively identified cases from February 1977 to May 1994 with first-time isolated carotid endarterectomy, coronary bypass, or combined procedures. In the isolated carotid endarterectomy population, median age was 69 years and 58% (85/146) were male, as compared with 68 years and 68% (68/100) male in the combined group; median age of the coronary bypass cohort was 65 years and 76% (381/500) male. A significantly higher percentage of patients in the coronary bypass versus combined group were in New York Heart Association functional class IV. In the combined group there was a significantly higher incidence of older age, diabetes, hypertension, hyperlipidemia, renal failure, and congestive heart failure. There was no difference among the three groups with respect to hospital mortality (0%, 3.4%, and 4.0%, respectively) and permanent stroke (0.7%, 1.2%, and 0%, respectively). Hospital costs were $4,896, $10,959 and $11,089, respectively, with a savings of $4,766 (30%), and Medicare hospital reimbursement was $8,575, $23,071, and $23,071, respectively, with a savings of $10,077 (25.3%). Thus, in appropriate patients, a combined procedure is cost effective, eliminating a second surgical procedure andthe cost of the postoperative stay (3.7 ± 2.4 days) associated with isolated carotid endarterectomy. Risk of permanent stroke or death is not increased. (J THORACCARDIOVASCSURG1996;111:1185-93)

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