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Impact of postoperative complications on hospital costs following the Norwood operation

  • Kimberly E. McHugh (a1), Sara K. Pasquali (a2), Matthew A. Hall (a3) and Mark A. Scheurer (a1)



Patients undergoing the Norwood operation consume considerable healthcare resources; however, detailed information regarding factors impacting hospitalisation costs is lacking. We evaluated the association of postoperative complications with hospital costs.


In the present study, we utilised a unique data set consisting of prospectively collected clinical data from the Pediatric Heart Network Single Ventricle Reconstruction trial linked at the patient level with cost data for 10 hospitals participating in the Children’s Hospital Association Case Mix database during the trial period. The relationship between complications and cost was modelled using linear regression, accounting for the skewed distribution of cost, adjusting for within-centre clustering and baseline patient characteristics.


A total of 334 eligible Norwood records (97.5%) were matched between data sets. Overall, 82% suffered from at least one complication (median 2; with a range from 0 to 33). Those with complications had longer postoperative length of stay (25 versus 12 days, p<0.001), more total ventilator days (7 versus 5 days, p<0.001), and higher in-hospital mortality (17.6 versus 3.4%, p<0.006). Mean adjusted hospital cost in those with a complication was $190,689 (95% CI $111,344–$326,577) versus $120,584 (95% CI $69,246–$209,983) in those without complications (p=0.002). Costs increased with the number of complications (1–2 complications=$132,800 versus 3–4 complications=$182,353 versus ⩾5 complications=$309,372 [p<0.001]).


This merged data set of clinical trial and cost data demonstrated that postoperative complications are common following the Norwood operation and are associated with worse clinical outcomes and higher costs. Efforts to reduce complications in this population may lead to improved outcomes and cost savings.


Corresponding author

Correspondence to: K. E. McHugh, MD, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC 29425, United States of America. Tel: 843 792 3292; E-mail:


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1. McHugh, KE, Hillman, DG, Gurka, MJ, Gutgesell, HP. Three-stage palliation of hypoplastic left heart syndrome in the University HealthSystem Consortium. Congenit Heart Dis 2010; 5: 815.
2. Graham, EM, Bradley, SM, Atz, AM. Preoperative management of hypoplastic left heart syndrome. Expert Opin Pharmacother 2005; 6: 687693.
3. Dean, PN, Hillman, DG, McHugh, KE, Gutgesell, HP. Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome. Pediatrics 2011; 128: e1181e1186.
4. Centers for Disease C, Prevention. Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defects – United States, 2003. Morbidity and Mortality Weekly Report 2007; 56: 2529.
5. Porter, ME. What is value in health care? N Engl J Med 2010; 363: 24772481.
6. Jantzen, DW, He, X, Jacobs, JP, et al. The impact of differential case ascertainment in clinical registry versus administrative data on assessment of resource utilization in pediatric heart surgery. World J Pediatr Congenit Heart Surg 2014; 5: 398405.
7. Pasquali, SK, He, X, Jacobs, ML, et al. Excess costs associated with complications and prolonged length of stay after congenital heart surgery. Ann Thorac Surg 2014; 98: 16601666.
8. Benavidez, OJ, Connor, JA, Gauvreau, K, Jenkins, KJ. The contribution of complications to high resource utilization during congenital heart surgery admissions. Congenit Heart Dis 2007; 2: 319326.
9. Pasquali, SK, Peterson, ED, Jacobs, JP, et al. Differential case ascertainment in clinical registry versus administrative data and impact on outcomes assessment for pediatric cardiac operations. Ann Thorac Surg 2013; 95: 197203.
10. Gutgesell, HP, Hillman, DG, McHugh, KE, Dean, P, Matherne, GP. Use of an administrative database to determine clinical management and outcomes in congenital heart disease. World J Pediatr Congenit Heart Surg 2011; 2: 593596.
11. Pasquali, SK, Sun, JL, d’Almada, P, et al. Center variation in hospital costs for patients undergoing congenital heart surgery. Circulation 2011; 4: 306312.
12. Ohye, RG, Gaynor, JW, Ghanayem, NS, et al. Design and rationale of a randomized trial comparing the Blalock-Taussig and right ventricle-pulmonary artery shunts in the Norwood procedure. J Thorac Cardiovasc Surg 2008; 136: 968975.
13. Pasquali, SK, Jacobs, JP, Shook, GJ, et al. Linking clinical registry data with administrative data using indirect identifiers: implementation and validation in the congenital heart surgery population. Am Heart J 2010; 160: 10991104.
14. Virzi, L, Pemberton, V, Ohye, RG, et al. Reporting adverse events in a surgical trial for complex congenital heart disease: the Pediatric Heart Network experience. J Thorac Cardiovasc Surg 2011; 142: 531537.
15. Aplenc, R, Fisher, BT, Huang, YS, et al. Merging of the National Cancer Institute-funded cooperative oncology group data with an administrative data source to develop a more effective platform for clinical trial analysis and comparative effectiveness research: a report from the Children’s Oncology Group. Pharmacoepidemiol Drug Saf 2012; 21 (Suppl 2): 3743.
16. Getz, KD, Li, Y, Alonzo, TA, et al. Comparison of in-patient costs for children treated on the AAML0531 clinical trial: a report from the Children’s Oncology Group. Pediatr Blood Cancer 2015; 62: 17751781.
17. Miller, TP, Troxel, AB, Li, Y, et al. Comparison of administrative/billing data to expected protocol-mandated chemotherapy exposure in children with acute myeloid leukemia: a report from the Children’s Oncology Group. Pediatr Blood Cancer 2015; 62: 11841189.
18. Pasquali, SK, Jacobs, ML, He, X, et al. Variation in congenital heart surgery costs across hospitals. Pediatrics 2014; 133: e553e560.
19. Frobert, O, Lagerqvist, B, Olivecrona, GK, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013; 369: 15871597.
20. Lauer, MS, D’Agostino, RB Sr. The randomized registry trial – the next disruptive technology in clinical research? N Engl J Med 2013; 369: 15791581.
21. Kogon, BE, Kanter, K, Alsoufi, B, Maher, K, Oster, ME. Please provide volume number for refernce 21.--> Outcomes and hospital costs associated with the Norwood operation: beyond morbidity and mortality. Cardiol Young 2015; 25: 853859.
22. Pasquali, SK, Ohye, RG, Lu, M, et al. Variation in perioperative care across centers for infants undergoing the Norwood procedure. J Thorac Cardiovasc Surg 2012; 144: 915921.
23. Dimick, JB, Chen, SL, Taheri, PA, Henderson, WG, Khuri, SF, Campbell, DA, Jr. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. Journal of the American College of Surgeons 2004; 199: 531537.


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