(P262) THE BURDEN OF HEART SURGERY COMPLICATIONS IN ALBERTA, CANADA

Background: Contemporary insights on the health services burden of postoperative complications following heart surgery in Canada are needed. We examined the mortality, healthcare resource use, and cost burden of complications after heart surgery in Alberta to support policy decision-making and quality of cardiac care improvements.

METHODS AND RESULTS: We conducted a population-based study using linked Alberta administrative health datasets of patients aged ≥18 years who underwent heart surgery between April 2019 and March 2022. Patients were categorized into three mutually exclusive groups: 1) isolated-coronary artery bypass grafting (CABG), 2) isolated-valve, and 3) combined CABG+valve based on the first (index) hospitalization episode with heart surgery during the study period. Patients surviving the index episode were followed for one year until death, moving out of the province, or being censored by March 2023.
The study cohort included 7,403 patients. The majority had isolated-CABG (45.4%) or isolated-valve (44.7%) surgery. There were fewer females (26.4%), and the mean age was 66.5 years. Hypertension (75%) and diabetes (37.2%) were the most prevalent comorbidities. Mortality was 0.6%, 0.9%, and 1.7% at 30-day, 90-day, and one-year post-discharge, respectively, and was lower in patients with isolated-CABG (Figure 1). Readmission at 30 days was similar across patient groups (isolated-CABG: 10.8%; isolated-valve: 11.6%; combined CABG+valve: 12.3%; p=0.434). However, patients with isolated-CABG were less likely to be readmitted (24%) than patients undergoing isolated-valve (30.8%; p< 0.001) and combined CABG+valve procedures (31.8%; p< 0.001) at one-year post-discharge. Accordingly, they incurred similar total healthcare costs at 30 days (p=0.265), but patients with isolated-CABG incurred significantly less than other groups at one year (p < 0.001) (Table 1). There were no differences in emergency department visits (57%) across patient groups (p=0.050). Total healthcare costs during one-year post-discharge were CA$75.2 million (or CA$25.1 million annually). Hospitalizations with dialysis (CA$6.8 million) and mechanical ventilation (CA$10.6 million) accounted for significant portions of total healthcare costs (9% and 14.1%, respectively), though few patients had these procedures during one year of follow-up.

Conclusion: Despite a low overall mortality, the health services burden of complications after heart surgery is high. Patients with isolated-CABG had better survival and incurred lower resource use and costs than those with isolated-valve or combined CABG+valve procedures. Although few patients had dialysis and mechanical ventilation in the hospital, they incurred substantial portions of the total costs during the follow-up, suggesting that targeted prevention and management of post-surgery complications could not only improve patient health outcomes but also alleviate the healthcare cost burden.