Outcomes and cost of coronary artery bypass graft surgery-in the United States and Canada

Background: We sought to determine whether there is a difference in in-hospital outcomes and costs for coronary artery bypass graft surgery (CABG) between the United States and Canada. Methods: We compared the outcomes and costs of treating 12 017 consecutive patients (4698 US and 7319 Canadian patients) undergoing CABG at 5 US and 4 Canadian hospitals. Participating hospitals used the same cost accounting system to provide patient-level clinical, resource utilization, and cost-of-treatment data (excluding physicians' fees). Canadian costs were converted to US dollars using purchasing power parities. Results: Compared with Canadian patients, US patients were older (mean +/- SD age, 68.0 +/- 10.4 vs 63.7 +/- 9.8 years [P <.001]), more likely to be female (27.4% vs 21.8% [P <.001]), and discharged from the hospital sooner (mean SD length of stay, 8.7 +/- 0.1 vs 9.5 +/- 0.1 days [P <.001]). In-hospital costs of treatment were substantially higher in the United States than in Canada (mean +/- SD cost, $20673 +/-$241 vs $10373 +/-$123 [P <.001]; median, $16 036 vs $7880). After controlling for demographic and clinical differences, length of stay in Canada was 16.8% longer than in the United States; there was no difference in in-hospital mortality; and the cost in the United States was 82.5% higher than in Canada (P <.001). Conclusions: The in-hospital cost of CABG in the United States is substantially higher than in Canada. This difference is due to higher direct and overhead costs in US hospitals, is not explained by demographic or clinical differences, and does not lead to superior clinical outcomes.