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Published on: July 18, 2014
Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome
Peter N Dean1, Diane G Hillman, Kimberly E McHugh
1Department of Pediatrics, University of Virginia Health System, Charlottesville, VA 22908-0386, USA.
Insights
Hypoplastic left heart syndrome (HLHS) care is resource-intensive, involving complex surgeries or transplants. Rising survival rates for HLHS patients have significantly increased hospital stays and associated costs.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Healthcare Resource Utilization
Background:
- Hypoplastic left heart syndrome (HLHS) is a severe congenital heart defect requiring complex management.
- Treatment typically involves staged palliative surgeries (Norwood-Glenn-Fontan pathway) or cardiac transplantation.
- Quantifying the inpatient resource burden is crucial for healthcare planning.
Purpose of the Study:
- To quantify the inpatient resource utilization for HLHS patients.
- To compare resource demands across different treatment strategies (staged palliation vs. transplantation).
- To analyze trends in resource use over time.
Main Methods:
- Utilized data from the University HealthSystem Consortium, encompassing 101 academic medical centers.
- Analyzed inpatient resource use for HLHS patients undergoing staged palliation or transplantation from 1998 to 2007.
- Examined length of stay (LOS) and financial charges associated with each treatment pathway.
Main Results:
- Stage 1 palliation (Norwood/Sano) had a median LOS of 25 days and charges of $214,680.
- Neonatal transplantation had a median LOS of 87 days and charges of $582,920.
- Between 1998 and 2007, LOS for stage 1 palliation increased from 16 to 28 days, with inflation-adjusted charges rising significantly due to improved survival rates (57% to 83%).
Conclusions:
- HLHS patients incur substantial inpatient resource burdens, irrespective of treatment via the Norwood-Glenn-Fontan pathway or transplantation.
- Increasing survival rates for HLHS are associated with longer hospital stays and higher healthcare costs.
- Effective resource management strategies are essential for addressing the growing demands of HLHS care.
Objective:
Hypoplastic left heart syndrome (HLHS) is one of the most serious congenital cardiac anomalies. Typically, it is managed with a series of 3 palliative operations or cardiac transplantation. Our goal was to quantify the inpatient resource burden of HLHS across multiple academic medical centers.
Methods:
The University HealthSystem Consortium is an alliance of 101 academic medical centers and 178 affiliated hospitals that share diagnostic, procedural, and financial data on all discharges. We examined inpatient resource use by patients with HLHS who underwent a staged palliative procedure or cardiac transplantation between 1998 and 2007.
Results:
Among 1941 neonates, stage 1 palliation (Norwood or Sano procedure) had a median length of stay (LOS) of 25 days and charges of $214,680. Stage 2 and stage 3 palliation (Glenn and Fontan procedures, respectively) had median LOS and charges of 8 days and $82,174 and 11 days and $79,549, respectively. Primary neonatal transplantation had an LOS of 87 days and charges of $582,920, and rescue transplantation required 36 days and $411,121. The median inpatient wait time for primary and rescue transplants was 42 and 6 days, respectively. Between 1998 and 2007, the LOS for stage 1 palliation increased from 16 to 28 days and inflation-adjusted charges increased from $122,309 to $280,909, largely because of increasing survival rates (57% in 1998 and 83% in 2007).
Conclusions:
Patients with HLHS demand considerable inpatient resources, whether treated with the Norwood-Glenn-Fontan procedure pathway or cardiac transplantation. Improved survival rates have led to increased hospital stays and costs.
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