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Variation in hospital costs and resource utilisation after congenital heart surgery

Published online by Cambridge University Press:  04 April 2022

Joshua J. Blinder*
Affiliation:
Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA
Yuan-Shung Huang
Affiliation:
Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Joseph W. Rossano
Affiliation:
Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Andrew T Costarino
Affiliation:
Division of Cardiac Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Yimei Li
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
*
Author for correspondence: Joshua J. Blinder, MD, Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, 750 Welch Road, Suite 321, Palo Alto, CA 94304, USA. Tel: +1 650-724-8075. E-mail: jblinder@stanford.edu

Abstract

Background:

Children undergoing cardiac surgery have overall improving survival, though they consume substantial resources. Nationwide inpatient cost estimates and costs at longitudinal follow-up are lacking.

Methods:

Retrospective cohort study of children <19 years of age admitted to Pediatric Health Information System administrative database with an International Classification of Diseases diagnosis code undergoing cardiac surgery. Patients were grouped into neonates (≤30 days of age), infants (31–365 days of age), and children (>1 year) at index procedure. Primary and secondary outcomes included hospital stay and hospital costs at index surgical admission and 1- and 5-year follow-up.

Results:

Of the 99,670 cohort patients, neonates comprised 27% and had the highest total hospital costs, though daily hospital costs were lower. Mortality declined (5.6% in 2004 versus 2.5% in 2015, p < 0.0001) while inpatient costs rose (5% increase/year, p < 0.0001). Neonates had greater index diagnosis complexity, greater inpatient costs, required the greatest ICU resources, pharmacotherapy, and respiratory therapy. We found no relationship between hospital surgical volume, mortality, and hospital costs. Neonates had higher cumulative hospital costs at 1- and 5-year follow-up compared to infants and children.

Conclusions:

Inpatient hospital costs rose during the study period, driven primarily by longer stay. Neonates had greater complexity index diagnosis, required greater hospital resources, and have higher hospital costs at 1 and 5 years compared to older children. Surgical volume and in-hospital mortality were not associated with costs. Further analyses comprising merged clinical and administrative data are necessary to identify longer stay and cost drivers after paediatric cardiac surgery.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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