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Factors associated with age at operation for children with congenital heart disease
R K Chang1, A Y Chen, T S Klitzner
1Division of Cardiology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California 90509, USA. rkchang@ucla.edu
Insights
Children with congenital heart disease (CHD) receive surgery at younger ages when they have private insurance and are treated at high-volume centers. Urban children with CHD tend to undergo surgery later.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Health Services Research
Background:
- Previous studies indicate children with congenital heart disease (CHD) from nonurban areas or without private insurance face delayed referrals.
- The impact of these socioeconomic factors on the timing of definitive surgical repair for pediatric CHD remains under-evaluated.
Purpose of the Study:
- To investigate factors influencing the age of definitive surgical repair for congenital heart disease in children.
- To analyze the roles of insurance type, geographic location, and surgical center volume in determining surgical timing.
Main Methods:
- Utilized California hospital discharge data from 1995-1996.
- Included children under 18 undergoing surgical repair for atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), or atrioventricular canal (AVC).
- Evaluated age at surgery based on CHD type, gender, race, insurance, surgical center, urban/rural location, and distance to the center.
Main Results:
- Surgery age varied by CHD type: AVC < TOF < VSD < ASD.
- Median age at operation showed a trend: private insurance < managed care < Medicaid.
- Higher surgical center case volume correlated with younger median age at operation for all CHD types.
- Urban children with ASD, VSD, and TOF tended to be older at surgery.
Conclusions:
- Nonmedical variables, including insurance type and surgical center volume, significantly impact the age of definitive CHD repair in children.
- Higher surgical case volumes at centers are associated with earlier surgical intervention.
- Children residing in urban areas may experience delayed surgery for specific CHDs (ASD, VSD, TOF).
Objective:
Previous studies have shown that children with congenital heart disease (CHD) who live in nonurban areas or who do not have private insurance are at risk for delayed referral to a pediatric cardiologist. However, the effect of these factors on the age at which cardiac surgery is performed has not been evaluated. This study is designed to evaluate the factors that influence the age at which definitive surgical repair is performed.
Methods:
Data on hospital discharges for 1995 and 1996 in California were obtained from the Office of Statewide Health Planning and Development database. Children <18 years who underwent surgical repair for atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), or atrioventricular canal (AVC) were included in the study. Age at surgery was evaluated using type of CHD, gender, race, type of insurance, surgical centers, urban or rural home location, and distance between home and surgical center as independent variables.
Results:
In 1995-1996, 666 children underwent ASD closure (mean age: 5.1 years; median: 4.0 years), 582 VSD closure (mean age: 2.8; median: 1.1 years), 394 TOF repair (mean age: 1.7; median:.9 years), and 177 AVC repair (mean age: 1.1; median:.6 years). Comparing median and mean age at surgery, we found: AVC
Conclusions:
Many medical and nonmedical variables play important roles in determining age for definitive repair of CHD in children. Type of insurance, a recognized surrogate for access to care, may play an important role. In addition, centers with higher surgical case volume were more likely to operate at a younger age. Finally, children in urban areas tend to be older at the time of surgery for ASD, VSD, and TOF.