Economic and clinical impact of routine weekend catheterization services

Kirsten Hall Long, James P. Moriarty, Jeanine E. Ransom, Ryan J. Lennon, Verghese Mathew, Rajiv Gulati, Gurpreet S Sandhu, Charanjit Rihal

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: To assess the impact of weekend cardiac catheterization (cath) services for nonemergent inpatients. Study Design: Retrospective cohort study of patients undergoing cath before and after Saturday cath service availability (CSA). Methods: Cohorts included Friday and Saturday admissions with cath (with or without revascularization) on the subsequent Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and Friday or Saturday admissions undergoing cath the subsequent or same Saturday from January 1, 2009, to December 31, 2010 (post-CSA events). Administrative and registry data provided demographics, comorbidities, percutaneous coronary intervention (PCI) details, adverse events, hospital length of stay (LOS), and inpatient expenditures. We used generalized linear modeling to predict LOS and costs, and logistic regression to estimate the likelihood of adverse events during follow-up. Results: We identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243 patients). Cohorts were similar in age (66 years), sex (59% male), and level of comorbidity. PCI use was higher following CSA (42% vs 26%; P <.001), with procedural success accomplished in 95% and 94% of pre- and post-CSA patients, respectively. Adjusted clinical outcomes were similar (odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P = .55; OR for 30-day revascularization, 1.14; P = .68). Models predict an average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001) yet inpatient costs were similar ($24,817 vs $24,753; 95% CI of difference, -$3611 to $3576). Conclusions: Weekend CSA for routine inpatients was clinically safe and effective, and reduced hospital LOS. Similar inpatient costs likely reflect a shift in case mix in this nonrandomized study.

Original languageEnglish (US)
Pages (from-to)e233-e240
JournalAmerican Journal of Managed Care
Volume22
Issue number7
StatePublished - Jul 1 2016

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Catheterization
Length of Stay
Economics
Inpatients
Percutaneous Coronary Intervention
Costs and Cost Analysis
Comorbidity
Odds Ratio
Diagnosis-Related Groups
Cardiac Catheterization
Health Expenditures
Hospital Mortality
Registries
Cohort Studies
Retrospective Studies
Logistic Models
Demography

ASJC Scopus subject areas

  • Health Policy

Cite this

Long, K. H., Moriarty, J. P., Ransom, J. E., Lennon, R. J., Mathew, V., Gulati, R., ... Rihal, C. (2016). Economic and clinical impact of routine weekend catheterization services. American Journal of Managed Care, 22(7), e233-e240.

Economic and clinical impact of routine weekend catheterization services. / Long, Kirsten Hall; Moriarty, James P.; Ransom, Jeanine E.; Lennon, Ryan J.; Mathew, Verghese; Gulati, Rajiv; Sandhu, Gurpreet S; Rihal, Charanjit.

In: American Journal of Managed Care, Vol. 22, No. 7, 01.07.2016, p. e233-e240.

Research output: Contribution to journalArticle

Long, KH, Moriarty, JP, Ransom, JE, Lennon, RJ, Mathew, V, Gulati, R, Sandhu, GS & Rihal, C 2016, 'Economic and clinical impact of routine weekend catheterization services', American Journal of Managed Care, vol. 22, no. 7, pp. e233-e240.
Long KH, Moriarty JP, Ransom JE, Lennon RJ, Mathew V, Gulati R et al. Economic and clinical impact of routine weekend catheterization services. American Journal of Managed Care. 2016 Jul 1;22(7):e233-e240.
Long, Kirsten Hall ; Moriarty, James P. ; Ransom, Jeanine E. ; Lennon, Ryan J. ; Mathew, Verghese ; Gulati, Rajiv ; Sandhu, Gurpreet S ; Rihal, Charanjit. / Economic and clinical impact of routine weekend catheterization services. In: American Journal of Managed Care. 2016 ; Vol. 22, No. 7. pp. e233-e240.
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abstract = "Objectives: To assess the impact of weekend cardiac catheterization (cath) services for nonemergent inpatients. Study Design: Retrospective cohort study of patients undergoing cath before and after Saturday cath service availability (CSA). Methods: Cohorts included Friday and Saturday admissions with cath (with or without revascularization) on the subsequent Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and Friday or Saturday admissions undergoing cath the subsequent or same Saturday from January 1, 2009, to December 31, 2010 (post-CSA events). Administrative and registry data provided demographics, comorbidities, percutaneous coronary intervention (PCI) details, adverse events, hospital length of stay (LOS), and inpatient expenditures. We used generalized linear modeling to predict LOS and costs, and logistic regression to estimate the likelihood of adverse events during follow-up. Results: We identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243 patients). Cohorts were similar in age (66 years), sex (59{\%} male), and level of comorbidity. PCI use was higher following CSA (42{\%} vs 26{\%}; P <.001), with procedural success accomplished in 95{\%} and 94{\%} of pre- and post-CSA patients, respectively. Adjusted clinical outcomes were similar (odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P = .55; OR for 30-day revascularization, 1.14; P = .68). Models predict an average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001) yet inpatient costs were similar ($24,817 vs $24,753; 95{\%} CI of difference, -$3611 to $3576). Conclusions: Weekend CSA for routine inpatients was clinically safe and effective, and reduced hospital LOS. Similar inpatient costs likely reflect a shift in case mix in this nonrandomized study.",
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