Coronary Angiography Utilization and Costs for Coronary Artery Bypass Graft Surgery Patients in Turkey

INTRODUCTION To assess excess use of coronary angiography prior to coronary artery bypass graft surgery and its association with mortality, health care costs, and hospital quality in Turkey. METHODS Using Turkish National Health Insurance Data (2009-2011) that included patients who underwent cardiac surgery, coronary angiography utilization was identified. Propensity score matching was used to compare survival rates and annual health care costs of patients in a coronary angiography excess-use group (>1 angiogram) and in a standard-therapy group (1 angiogram). The empirical Bayesian approach was used to combine mortality and hospital volume for quality index. The relationship between hospital quality and excess use of coronary angiography was assessed using Chi-squared tests. RESULTS Out of 20,126 patients identified, 7.27% of patients underwent excessive coronary angiography procedures (excess-use group), with an average annual cost at 9.7% higher than those who had a single angiography (standard-therapy group; P < 0.01). Operational mortality associated with excessive use was significantly higher as well (7.4% versus 5.4%, P < 0.02). There exists variation in the use of coronary angiography across cities and hospitals. Patients who underwent cardiac surgery in high-quality hospitals were less likely to have excessive angiography use than those in low-quality hospitals (7.0% versus 9.5%, P < 0.01). CONCLUSION In Turkey, excess use of coronary angiography prior to coronary artery bypass graft surgery is associated with higher operational mortality, higher expenditures, and lower hospital quality.