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American Journal of Critical Care. 2002;11: 228-238
Copyright © 2002 by the American Association of Critical-Care Nurses.
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Resource Utilization Related to Atrial Fibrillation After Coronary Artery Bypass Grafting

By Marilyn Hravnak, RN, PhD, Leslie A. Hoffman, RN, PhD, Melissa I. Saul, MS, Thomas G. Zullo, PhD and Gayle R. Whitman, RN, PhD. From the Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh (MH, LAH, TGZ, GRW) and Medical Archival Retrieval System, Inc. (MIS), University of Pittsburgh Medical Center–Health System, Pittsburgh, Pa.

• Background Studies of resource utilization by patients with new-onset atrial fibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges.

• Objective To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrial fibrillation after isolated coronary artery bypass grafting.

• Methods Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center. The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrial fibrillation.

• Results The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrial fibrillation, subjects with atrial fibrillation had a longer stay (5.8 ± 2.4 vs 4.4 ± 1.2 days, P< .001), more days receiving mechanical ventilation (P=.002) and oxygen therapy (P< .001), and higher rates of readmission to the intensive care unit (4.6% vs 0.2%, P< .001). Subjects with atrial fibrillation also had more laboratory tests (P< .001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrial fibrillation had higher total postoperative charges ($57261 ± $17 101 vs $50 905 ± $10 062, P = .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582).

• Conclusions The economic impact of atrial fibrillation after coronary artery bypass grafting has been underestimated.




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