Introduction

Cardiac surgery and cardiac critical care are expensive endeavours. Intraoperative costs of coronary artery bypass grafting (CABG) and cardiac valve operations are among the highest when compared with other surgical procedures. Once the surgical procedure has finished, the costs continue to rise because of the expensive postoperative care provided in the critical care unit. Although the proportionate use of CABG to treat coronary artery disease is declining owing to increasing numbers of percutaneous coronary interventions, there are still many cardiac surgical operations performed each year worldwide. The profile of patients presenting has changed, and cardiac surgery is increasingly performed on elderly patients with extensive coronary artery disease and numerous medical comorbidities. These patients can be expected to have lengthier recovery periods and an increased chance of postoperative complications, further increasing costs.

Coinciding with the high demand for cardiac surgical procedures and critical care are institutional and societal pressures to contain costs within the health care arena. The motto of health care management since the 1990s has been to ‘do more with less.’ The aim is therefore to attain the best possible combination of excellent clinical outcomes, patient safety and cost containment.

Factors influencing the cost of cardiac surgery

The strongest predictors of cost for cardiac surgical patients are:

1. hospital length of stay (LOS);

2. critical care LOS;

3. operating room time;

4. patient age; and

5. postoperative complications (such as sternal wound infection, respiratory failure, left ventricular failure, and death).