Evaluating Healthcare Resource Utilization and Associated Costs for Patients with New-onset Post-operative Atrial Fibrillation

Abstract

BACKGROUND: New-onset post-operative atrial fibrillation (POAF) is one of the most common complications following cardiac surgery. Previous studies have found that patients with POAF experience longer hospital lengths of stay and as well as higher morbidity and mortality after discharge. Several studies have assessed the short-term costs associated with POAF. There is a general consensus that POAF is associated with significantly higher costs, but most studies are confined to a single center or a cluster of centers and estimates vary widely between studies. Furthermore, much less is known about the long-term consequences of POAF.OBJECTIVE: To assess the short-term (30-day) and long-term (1-year) incremental healthcare resource utilization and costs associated with POAF. METHODS: We conducted a retrospective cohort study using claims data from the IBM Watson MarketScan® national database. A cohort of adults between the ages of 55 and 90 who underwent open-chest cardiac surgery between January 1, 2017 and December 31, 2018 was used to compare patients who experienced POAF to those who did not. The date of surgery served as the index date for each patient and baseline characteristics were assessed during the 12-month pre-index period. The outcomes of interest were healthcare resource utilization (HRU) and total healthcare costs. Outcomes were assessed during the index hospitalization, 30-days post-discharge, and 1-year post-discharge time periods. Inverse probability weighting was used to adjust for confounding baseline characteristics. RESULTS: A total of 8,020 patients met the study inclusion criteria with 5,765 patients in the control cohort and 2,255 patients in the POAF cohort. The mean age of patients in the control group was 63.4 years, and in the POAF group was 65.8 years. After adjustment, patients with POAF had an index hospitalization that was 1.9 days longer (99%CI 1.3, 2.4 days, p < 0.001) and $13,919 more costly (99%CI $2,828, $25,011, p < 0.001). POAF patients had significantly higher HRU at 30 days and 1 year, amounting to incremental costs of $4,649 (99%CI $1,479, $7,819, p < 0.001) and $10,671 (99%CI $2,407, $18,935, p < 0.001) respectively. CONCLUSION: Among patients who underwent open-chest cardiac surgery, patients who experienced POAF had statistically significantly higher HRU and costs during the index hospitalization, at 30 days, and at 1 year compared to patients who did not experience POAF.