Abstract 11846: Excess Healthcare Costs and Bed Days Associated With Complications Following Catheter Ablation of Atrial Fibrillation

Background: Complications following catheter ablation of atrial fibrillation (AF) have been extensively examined but little is known about their associated economic burden. Hypothesis: Complications of AF ablations were associated with a significant increase in healthcare resources utilization. Methods: All patients >18 years undergoing AF ablations in the financial years of 2011-2017 in Australia with available cost data from the National Hospital Cost Data Collection were included. The primary outcome was occurrence of any complications up to 30-days post-discharge. All costs were adjusted to 2021 Australian dollars. The increase in length of stay (LOS) and in cost associated with complications, adjusting for patient characteristics, was evaluated using generalized linear models and negative binomial regression. Results: Our study included 19,916 patients (mean age 62.6±11.3 years, 30.2% females). The median length of stay was 1 day (interquartile range [IQR] 1-2 days) and the median cost per hospitalization was $6,646.5 (IQR $5,979.7-$10,210.5). A total of 1,074 patients (5.39%) experienced a complication (4.24% during the hospital stay and 1.37% post-discharge). The most common complications were bleeding (3.18%), pericardial effusion (0.66%), and vascular injury (0.43%). On average, the occurrence of a complication was associated with 2.8 excess bed-days and a $6,119.4 (95%CI $5,491.2-$6,747.7) increase in hospitalization cost (totaling nearly $6.6 millions). Complications that required cardiac surgery were associated with the highest incremental cost per patient ($19,958.5 [95%CI $17,304.5-$22,612.6]) but most of excess cost was attributable to bleeding ($4,808.5 per patient, $3,048,596.1 in total, 44.4% of total excess cost) and pericardial effusion ($6,064.8 per patient, $1,073,094.9 in total, 16.3% of total excess cost). Conclusions: The occurrence of any complication following AF ablation is associated with a significant economic burden, most of which was attributable to bleeding and pericardial effusion. Strategies to improve procedural safety and reduce healthcare cost should focus on these complications.