Resource Utilization for Prenatally Diagnosed Single-Ventricle Cardiac Defects: A Philadelphia Fetus-to-Fontan Cohort...

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Healthcare Resource Management

Background:

• Single-ventricle cardiac defects (SVCD) necessitate extensive healthcare resources from fetal diagnosis through complex surgical palliation.
• Understanding resource utilization patterns is crucial for managing patients with SVCD and informing prenatal counseling.

Purpose of the Study:

• To characterize and identify variables influencing healthcare resource utilization in patients diagnosed with SVCD prenatally.
• To analyze resource use from fetal diagnosis through outcomes such as death, completed staged palliation, or cardiac transplant.

Main Methods:

• Retrospective review of patients with prenatal SVCD diagnosis (2004-2011) who received exclusive cardiac care at the institution.
• Primary endpoints included total hospitalization days, echocardiograms, and cardiac catheterizations.
• Subanalysis focused on survivors of completed staged palliation, examining factors like Norwood operation and ventricular morphology.

Main Results:

• Of 202 patients, 136 survived to 6 months post-palliation. Median hospitalization was 25.1 days/patient-year, with 7.2 echocardiograms and 0.7 catheterizations annually.
• Mortality correlated with higher resource utilization.
• Survivors of staged palliation averaged 57 hospital days and underwent 21 echocardiograms and 2 catheterizations. Right-ventricle dominant lesions needing the Norwood operation showed increased resource use.

Conclusions:

• Fetuses with SVCD and dominant right-ventricular morphology requiring the Norwood operation incur higher resource utilization, irrespective of mortality.
• Findings offer insights into SVCD management, aid prenatal counseling precision, and quantify resources for successful SVCD care.