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Differences in clinical outcomes and cost between complex and simple arterial switches
Eric R Griffiths1, Nelangi M Pinto2, Aaron W Eckhauser1
11Division of Pediatric Cardiac Surgery,University of Utah,Salt Lake City,Utah,United States of America.
Insights
Complex arterial switch operations have similar safety profiles to simple ones, but incur higher costs. These findings are crucial for understanding the economic implications of complex cardiac surgeries.
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.
Background:
This study evaluates the morbidity, mortality, and cost differences between patients who underwent either a simple or a complex arterial switch operation.
Methods:
A retrospective study of patients undergoing an arterial switch operation at a single institution was performed. Simple cases were defined as patients with d-transposition of the great arteries with usual coronary anatomy or circumflex artery originating from the right with either intact ventricular septum or ventricular septal defect. Complex cases included all other forms of coronary anatomy, aortic coarctation or arch hypoplasia, and Taussig-Bing anomalies. Costs were acquired using an institutional activity-based accounting system.
Results:
A total of 98 patients were identified, 68 patients in the simple group and 30 in the complex group. The mortality rate was 2% for the simple and 7% for the complex group, p=0.23. Major morbidities including cardiac arrest, extracorporeal membrane oxygenation, a major coronary event, surgical or catheter-based re-intervention, stroke, or permanent pacemaker placement, non-cardiac surgical procedures, mediastinitis, and sepsis did not differ between the simple and complex groups (16 versus 27%, p=0.16). The complex group had increased bleeding requiring re-exploration (0 versus 10%, p=0.04). Hospital and ICU length of stay did not differ. Complex patients had higher overall hospital costs (simple $80,749 versus complex $97,387, p=0.01) and higher postoperative costs (simple $60,192 versus complex $70,132, p=0.02). The operating room and supplies accounted for the majority of the cost difference.
Conclusion:
Complex arterial switches can be safely performed with low rates of morbidity and mortality but at an increased cost.
