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Center variation in hospital costs for patients undergoing congenital heart surgery

Sara K Pasquali1, Jie-Lena Sun, Phil d'Almada

  • 1Divisions of Pediatric Cardiology and Cardiothoracic Surgery and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA. sara.pasquali@duke.edu

Circulation. Cardiovascular Quality and Outcomes
|April 21, 2011
PubMed

Insights

Hospital costs for congenital heart surgery vary significantly by medical center. Higher-volume centers demonstrated lower costs for simpler procedures like atrial septal defect and ventricular septal defect repair.

Area of Science:

  • Pediatric Cardiology
  • Health Services Research
  • Healthcare Economics

Background:

  • Congenital heart disease (CHD) incurs substantial healthcare costs.
  • Limited data exist on factors influencing resource utilization in CHD care.
  • Understanding cost variations is crucial for optimizing healthcare delivery.

Purpose of the Study:

  • To assess inter-center variations in total hospital costs for four types of congenital heart operations.
  • To identify factors associated with these cost differences.

Main Methods:

  • Utilized the Premier Database (2001-2007) for cost analysis.
  • Included 2124 pediatric patients undergoing atrial septal defect (ASD) repair, ventricular septal defect (VSD) repair, tetralogy of Fallot (TOF) repair, or arterial switch operation (ASO).
  • Employed mixed-effects models to evaluate center impact on costs, adjusting for patient/center characteristics and length of stay.

Main Results:

  • Total hospital costs ranged from median $12,761 (ASD repair) to $55,430 (ASO), increasing with surgical complexity.
  • Center effects significantly impacted total hospital costs for all four procedures (P≤0.01).
  • Center variation accounted for 19% of costs for ASD repair, 11% for VSD repair, 6% for TOF repair, and 3% for ASO.
  • Higher-volume centers showed lower costs for ASD and VSD repairs, but not for TOF repair or ASO.

Conclusions:

  • Significant center-based variations in total hospital costs exist for congenital heart surgeries, persisting after adjustments.
  • Cost disparities were most pronounced for less complex procedures.
  • Center volume influences cost-effectiveness for specific congenital heart operations.
Abstract

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