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Relationship between resource utilization and length of stay following tetralogy of Fallot repair
Matthew E Oster1, April L Dawson, Cara M Batenhorst
1Emory University Rollins School of Public Health, Atlanta, Ga, USA; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga, USA.
Insights
Increased resource utilization, including total and laboratory costs in the first three days after surgery for tetralogy of Fallot (TOF), is linked to a longer postoperative length of stay (PLOS). Higher costs do not shorten recovery time.
Area of Science:
- Pediatric Cardiac Surgery
- Health Economics
- Healthcare Resource Utilization
Background:
- The association between resource utilization and postoperative length of stay (PLOS) after congenital heart disease surgery remains unclear.
- Understanding this relationship is crucial for optimizing patient care and hospital resource management.
Purpose of the Study:
- To investigate the relationship between resource utilization (total, laboratory, and imaging costs) during the early postoperative period and PLOS in pediatric patients undergoing tetralogy of Fallot (TOF) repair.
- To determine if increased early resource expenditure is associated with shorter or longer hospital stays.
Main Methods:
- Retrospective cohort study using the Pediatric Health Information Systems database (2004-2008).
- Inclusion of 1161 infants (1 month to 1 year) undergoing elective, complete TOF repair.
- Generalized linear models were used to assess the impact of early costs on PLOS, controlling for patient and hospital factors.
Main Results:
- Mean PLOS was 7.1 days. Mean early costs were $26,455 (total), $2941 (laboratory), and $813 (imaging).
- A $4600 increase in total costs or $700 in laboratory costs within the first three postoperative days was associated with a 1-day increase in PLOS.
- Imaging costs showed no association with PLOS.
Conclusions:
- Increased resource utilization, particularly total and laboratory costs in the early postoperative phase, is not associated with a shorter PLOS after elective TOF repair.
- Higher early resource expenditure may be linked to a prolonged postoperative length of stay, suggesting potential inefficiencies or complexities in care.
Background:
The relationship between resource utilization and postoperative length of stay (PLOS) following congenital heart disease surgery is unknown.
Methods:
We performed a retrospective cohort study using data from the Pediatric Health Information Systems database. We included subjects 1 month to 1 year of age with a PLOS of ≤ 1 month following elective, complete repair of tetralogy of Fallot (TOF) during 2004-2008 at children's hospitals that performed ≥ 10 such surgeries during the study period. We constructed three generalized linear models to assess the relationships of total costs, laboratory costs, and imaging costs during the first three postoperative days with overall PLOS. Race/ethnicity, insurance type, sex, and presence of a genetic syndrome (by ICD-9 codes) were included in the models as fixed effects; hospital of surgery was included as a random effect.
Results:
For 1161 eligible surgical encounters at 36 children's hospitals, mean PLOS was 7.1 days (median = 6 days). Mean total, laboratory, and imaging costs for the first three postoperative days were $26,455, $2941, and $813, respectively. Most subjects were male (58.9%), did not have a genetic syndrome (88.3%), were non-Hispanic white (58.3%), and had either public or private insurance (41.0% and 39.1%, respectively). An estimated increase in total costs of $4600 or laboratory costs of $700 in the first three postoperative days was associated with a 1-day increase in PLOS. Imaging costs were not associated with PLOS.
Conclusions:
Increased resource utilization is not associated with a shorter PLOS following elective TOF repair, and it may be associated with longer PLOS.