Differences in clinical outcomes and cost between complex and simple arterial switches

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Health Economics

Background:

• The arterial switch operation (ASO) is a critical procedure for treating d-transposition of the great arteries.
• Evaluating outcomes based on surgical complexity is essential for optimizing patient care and resource allocation.

Purpose of the Study:

• To compare morbidity, mortality, and cost differences between simple and complex arterial switch operations.
• To identify specific factors contributing to cost variations in ASO procedures.

Main Methods:

• Retrospective analysis of 98 patients undergoing ASO at a single institution.
• Classification of ASO cases into simple and complex based on coronary anatomy and associated anomalies.
• Utilized institutional activity-based accounting for cost acquisition.

Main Results:

• No significant differences in mortality (2% vs. 7%) or major morbidities (16% vs. 27%) between simple and complex ASO groups.
• Complex ASO group showed increased bleeding requiring re-exploration (10% vs. 0%).
• Complex ASO patients incurred higher overall hospital costs ($97,387 vs. $80,749) and postoperative costs ($70,132 vs. $60,192), primarily due to operating room and supply expenses.

Conclusions:

• Complex arterial switch operations can be performed safely with comparable morbidity and mortality rates to simple procedures.
• Increased costs associated with complex ASO are primarily driven by surgical and supply-related expenses.
• Despite higher costs, complex ASO is a viable and safe option for specific patient populations.