Clinical and economic benefits of an anticoagulation management service (AMS) for cardiac surgery patients

Excerpt

Management of anticoagulation in hospitalized patients with multiple medications and co-morbid conditions can be challenging, particularly after major surgery. Previous studies have demonstrated the value of specialized anticoagulation management services, especially in the outpatient setting. The purpose of our retrospective study was to determine the clinical and economic benefits of an inpatient anticoagulation management service (AMS) in post-operative cardiac surgery patients. Using administrative and clinical databases, we assessed the impact of specialized anticoagulation management on clinical and economic measures in consecutive cardiac surgery patients hospitalized before (1/1/03–5/30/05) and after (6/1/05–12/31/05) provision of specialized AMS on the cardiac surgery service. Outcome measures were the number of INR values >5, the number of clinically significant episodes of bleeding or thromboembolism (venous thromboembolism or cerebrovascular accident), the post-surgical length of stay (LOS) and the total attributable costs of hospitalization and re-operation for bleeding. Comparisons between the study groups (before and after the AMS) were conducted using a chi-square or Fisher’s exact test for categorical measures and a student’s t-test or Wilcoxon rank sum test for continuous outcome measures. For all tests of statistical significance, P-values <0.05 were considered statistically significant. Analyses were performed using STATA, version 9.0 (Stata Corp., College Station, TX). Eight hundred twenty seven patients were admitted during the study period, 674 patients before and 153 patients after institution of the AMS. AMS care was associated with a decrease in the percent of patients with INR values >5 (13% vs. 7%, P = 0.036) and a trend toward fewer bleeding episodes requiring a return visit to the operating room (8 vs. 0, P > 0.05). No difference in post-operative thromboembolic events (8% vs. 11%, P > 0.05) was noted. Post-operative LOS declined from 13.9 days to 11.6 days after initiation of the AMS (P = 0.015). The annual attributable cost savings of AMS care was estimated to be $280,000. Our study demonstrates that a specialized inpatient AMS is associated with improved clinical and economic outcomes for cardiac surgery patients. …