National trends in adult cardiac surgery inpatient costs: A decade in review

To characterize national trends in inpatient costs associated with adult cardiac surgery from 2013 to 2022 and identify factors independently associated with increased hospitalization expenditures. All hospitalizations entailing major cardiac operations (coronary artery bypass grafting, valve procedures [open and transcatheter], aortic repair) were identified in the 2013-2022 National Inpatient Sample. Temporal trends were evaluated using the Cuzick test for trend (nptrend), and multivariable linear regression was used to identify factors associated contemporary costs (2022). Among an estimated 3,323,645 admissions, annual volume increased from 293,645 to 361,355 (nptrend = 0.01). Elective hospitalization costs increased from $8.1 to $12.9 billion (nptrend < 0.001), with median per-admission costs increasing from $41,000 to $48,000 (nptrend < 0.001). For nonelective hospitalizations, total costs rose from $8.3 to $10.4 billion (nptrend = 0.01), and median per-admission costs from $51,000 to $63,000 (nptrend < 0.001). The proportion of transcatheter valve procedures rose from 6.4% to 38.9% (nptrend < 0.001), whereas their median per-admission costs decreased. In 2022, Black race (β $9,300, 95% confidence interval [CI], $6700-$11,800) and care in the Western United States (β $12,800, 95% CI, $7600-$17,900) were associated with increased costs. Elective admission (β –$26,000, 95% CI, –$27,900 to –$24,200), older age (β –$1400 per decade, 95% CI, –$2100 to –$800), and lowest income quartile (β –$3200, 95% CI, –$5700 to –$800; ref: highest) were associated with lower costs. Inpatient cardiac surgery costs increased significantly over the decade. These trends, alongside increased use of transcatheter techniques and persistent disparities, underscore the need for systemic reform to ensure sustainable and equitable care.