Hospital Costs Related to Early Extubation After Infant Cardiac Surgery

Area of Science:

• Pediatric Cardiology
• Health Services Research
• Clinical Economics

Background:

• The Pediatric Heart Network Collaborative Learning Study (PHN CLS) implemented a clinical practice guideline (CPG) to increase early extubation rates in infants undergoing repair for tetralogy of Fallot (TOF) and coarctation of the aorta (CoA).
• The economic impact of this CPG on hospital costs remained unstudied prior to this research.

Purpose of the Study:

• To evaluate the effect of the PHN CLS CPG on hospital costs associated with infant TOF and CoA repair.
• To determine if the observed cost changes at active sites exceeded secular trends seen in control sites.

Main Methods:

• Clinical data from 410 patients (96% of eligible) across four active and four control sites were linked with hospital cost data.
• Generalized linear mixed-effects models and a difference-in-difference approach were used to compare costs in pre- and post-CPG periods between active and control sites.

Main Results:

• Mean adjusted costs for TOF repair decreased by 27% at active sites post-CPG ($42,833 vs $56,304), while remaining unchanged at control sites ($47,007 vs $46,476).
• Significant cost reductions in the TOF cohort at active sites were observed in clinical, pharmacy, lab, and imaging categories.
• No significant changes in hospital costs were found for CoA repair at either active or control sites.

Conclusions:

• The early extubation CPG successfully reduced hospital costs for infant TOF repair, demonstrating a dual benefit of improved clinical outcomes and cost savings.
• The CPG did not yield similar cost reductions for infant CoA repair.
• This CPG offers a valuable strategy for optimizing both clinical results and healthcare expenditures in specific infant cardiac surgical procedures.