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Hawkins et al. Vessel Plus 2022;6:42 https://dx.doi.org/10.20517/2574-1209.2021.116 Page 9 of 11

Figure 2. Mean cost for each subgroup and total hospital cost over time.

stages of postoperative care (ICU, acute care, and outpatient).

In the current environment of quality improvement and focus on protocol-driven care, it is critical to
evaluate and understand the implications of postoperative complications as well as targeted approaches to
reduce these events. Prophylactic amiodarone is one such intervention that has been demonstrated to
reduce the rate of POAF [20-23] . Our group has previously evaluated the cost-effectiveness of this intervention
[11]
demonstrating prophylactic amiodarone was cost-effective with a savings of $458 per patient treated .
While there are many pitfalls in designing, implementing, and evaluating the success of targeted
interventions, it is critical to continuously analyze the outcome to ensure continued effectiveness . Cardiac
[24]
surgery programs may be inundated with various protocols and initiatives to improve the overall care of
patients. However, using the value framework, these initiatives should be evaluated on the basis of cost-
effectiveness using specific cost estimates that have been derived in this study. The persistence of POAF and
stability of cost implications over time shows the difficulty in implementing protocols to reduce its impact
on clinical outcomes and resource utilization.

Given the current crisis in healthcare costs and lack of transparency in pricing, it is critical to define
resource utilization. In order to more appropriately account for these healthcare-related expenses, it is
paramount to understand and quantify the impact of adverse events after cardiac surgery. A recent paper
from our group investigated the effects of bundled payments for CABG and identified postoperative
[14]
complications, including POAF, to be a major driver of cost variability . Any moves toward bundled
payment will include postoperative care, typically up to 90 days. Our finding of an 18% increase in
discharges to a facility significantly increases overall resource utilization, and in a way that hospitals and
practices may be responsible for in the future. Additionally, the COVID-19 pandemic has stressed our
health systems to the breaking point, highlighting the importance of resources, including bed allocation,
critical care resources, and healthcare providers. By better understanding and predicting the complex
healthcare needs of cardiac surgery patients, we can allocate appropriate resources and develop health
system-wide strategic plans.