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Economic and safety implications of introducing fast tracking in congenital heart surgery
Emily J Lawrence1, Khanh Nguyen, Shaine A Morris
1Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Insights
Fast-tracking pediatric congenital heart surgery significantly reduced hospital stays and costs at one center. This approach proved effective without increasing mortality or readmissions, offering a valuable model for healthcare efficiency.
Area of Science:
- Pediatric Cardiac Surgery
- Healthcare Management
- Health Economics
Background:
- Limited data exists on the feasibility of fast-tracking pediatric congenital heart disease (CHD) surgeries.
- Existing knowledge relies on small, single-center studies lacking control groups.
Purpose of the Study:
- To assess the effectiveness of fast-tracking in pediatric CHD surgery.
- To compare outcomes at a center implementing fast-tracking with national data.
Main Methods:
- Comparative analysis of administrative data for atrial septal defect (ASD) and ventricular septal defect (VSD) surgeries.
- Inclusion of children aged 2 months to 19 years undergoing ASD and VSD closure.
- Comparison of data from Mount Sinai Medical Center (MSMC) with 40 centers in the Pediatric Health Information System.
Main Results:
- Median length of stay at MSMC decreased by 1 day post-fast-tracking implementation for ASD and VSD closures.
- National median length of stay remained unchanged during the same period.
- Hospitalization costs decreased by 33% (ASD) and 35% (VSD) at MSMC, while national costs increased by 16-17%.
Conclusions:
- Fast-tracking implementation led to significantly shorter hospital stays and reduced costs at MSMC compared to national trends.
- No significant changes in hospital mortality or 2-week readmission rates were observed post-fast-tracking.
- The study demonstrates the successful feasibility of fast-tracking in pediatric congenital heart surgery.
Background:
The feasibility of fast-tracking children undergoing congenital heart disease surgery has not been assessed adequately. Current knowledge is based on limited single-center experiences without contemporaneous control groups.
Methods And Results:
We compared administrative data for atrial septal defect (ASD) and ventricular septal defect (VSD) surgeries in children 2 months to 19 years of age at the Mount Sinai Medical Center (MSMC) with data from comparable patients at 40 centers contributing to the Pediatric Health Information System. Three-year blocks, early in and after fast tracking had been implemented at the MSMC, were examined. Seventy-seven and 89 children at MSMC undergoing ASD and VSD closure, respectively, were compared with 3103 ASD and 4180 VSD patients nationally. With fast tracking fully implemented, median length of stay at the MSMC decreased by 1 day compared with the earlier era (length of stay, 1 and 3 days for ASD and VSD, respectively). Nationally, median length of stay remained unchanged (3 days for ASD and 4 days for VSD) in the observed time periods. Hospitalization costs fell by 33% and 35% at MSMC (ASD and VSD, respectively), whereas they rose by 16% to 17% nationally. When analyzed in multiple regression models, the decrease in both length of stay and cost remained significantly greater at MSMC compared with nationally (P<0.0001 for all). Hospital mortality and 2-week readmission rates were unchanged at MSMC between the 2 time periods and were not different from the national rates.
Conclusion:
Shorter length of stay and cost savings compared with national data were observed after implementation of fast tracking.