| Summary: | Resumo: Introdução: O pagamento da cirurgia cardíaca é feito com base num contrato entre os hospitais e o ministério da Saúde. Comparámos o preço com o custo apurado num serviço específico, nos doentes com idade igual ou superior a 65 anos. Material e métodos: Estudo prospetivo entre setembro 2011 e setembro 2012 em 250 doentes submetidos a cirurgia de revascularização coronária (n = 67), valvular (n = 156) e coronária associada a valvular (n = 27). Os custos foram apurados sempre que possível pelo método de microcusteio em alternativa pelo valor médio. O preço por doente foi facultado pela administração hospitalar, calculado usando o case mix médio do centro hospitalar. Resultados: Mortalidade aos 30 dias foi de 3,2%. Euroscore I médio foi 5,97 Desvio Padrão (DP) 4,50% significativamente inferior na cirurgia coronária. Tempo médio de UCI (3,27 DP 4,7), internamento total (9,92 DP 6,30) dias, ambos significativamente inferiores na cirurgia coronária isolada. Os custos apurados para cirurgia coronária foram 6539,17 DP 3990,26 €, valvulares 8289,72 DP 3319,93 €, valvulares com coronária associada 11 498,24 DP 10 470,57 €. Cada doente foi pago em 2011 a 4732,38 € e em 2012 4678,66 € usando o case mix do centro hospitalar que foi em 2011 2,06 e em 2012 2,17. O case mix da amostra foi em 2011 6,48 e em 2012 6,26. Conclusão: O preço pago por doente foi inferior ao custo apurado. Caso tivesse sido usado o case mix da amostra, o preço teria sido superior ao custo. A cirurgia coronária é significativamente mais barata do que a valvular. Abstract: Introduction: Payment for cardiac surgery in Portugal is based on a contract agreement between hospitals and the health ministry. Our aim was to compare the prices paid according to this contract agreement with calculated costs in a population of patients aged ≥65 years undergoing cardiac surgery in one hospital department. Methods: Data on 250 patients operated between September 2011 and September 2012 were prospectively collected. The procedures studied were coronary artery bypass graft surgery (CABG) (n=67), valve surgery (n=156) and combined CABG and valve surgery (n=27). Costs were calculated by two methods: micro‐costing when feasible and mean length of stay otherwise. Price information was provided by the hospital administration and calculated using the hospital's mean case‐mix. Results: Thirty‐day mortality was 3.2%. Mean EuroSCORE I was 5.97 (standard deviation [SD] 4.5%), significantly lower for CABG (p<0.01). Mean intensive care unit stay was 3.27 days (SD 4.7) and mean hospital stay was 9.92 days (SD 6.30), both significantly shorter for CABG. Calculated costs for CABG were €6539.17 (SD 3990.26), for valve surgery €8289.72 (SD 3319.93) and for combined CABG and valve surgery €11 498.24 (SD 10 470.57). The payment for each patient was €4732.38 in 2011 and €4678.66 in 2012 based on the case‐mix index of the hospital group, which was 2.06 in 2011 and 2.21 in 2012; however, the case‐mix in our sample was 6.48 in 2011 and 6.26 in 2012. Conclusion: The price paid for each patient was lower than the calculated costs. Prices would be higher than costs if the case‐mix of the sample had been used. Costs were significantly lower for CABG. Palavras‐chave: Custos, Cirurgia cardíaca, Preço, Case mix, Keywords: Costs, Cardiac surgery, Price, Case mix
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