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Costs of postoperative morbidity following paediatric cardiac surgery: observational study
Emma Hudson1, Katherine Brown2, Christina Pagel3,4
1Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK eh645@medschl.cam.ac.uk.
Insights
Postoperative morbidities following paediatric cardiac surgery significantly increase hospital costs by 22.3% and place a £21 million annual burden on the UK health service. Understanding these costs aids quality improvement initiatives.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Paediatric Care
Background:
- Advancements in paediatric cardiac surgery have reduced mortality rates.
- There is a need for alternative indicators of care quality, such as postoperative morbidities.
- The financial impact of these morbidities remains largely unknown.
Purpose of the Study:
- To calculate the costs associated with postoperative morbidities in paediatric cardiac surgery.
- To determine the impact of morbidities on per-patient, hospital, and national health service costs.
Main Methods:
- A case-matched cohort study and prospective incidence rate measurement were employed.
- Data were collected from five specialist UK paediatric cardiac surgery centres.
- Risk-adjusted regression modelling and extrapolation using audit data were used to calculate costs.
Main Results:
- Seven of ten morbidity categories incurred significant additional costs per patient, ranging from £7,483 to £66,784.
- Postoperative morbidities collectively increased hospital costs by an average of 22.3%.
- The total annual financial burden on the UK health service exceeded £21 million.
Conclusions:
- Postoperative morbidities represent a substantial financial burden in paediatric cardiac surgery.
- These findings can assist clinical teams and providers in cost accounting and quality improvement efforts.
- Quantifying morbidity costs is crucial for resource allocation and evaluating care quality.
Objective:
Early mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery.
Design:
Two methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively.
Setting:
Five specialist paediatric cardiac surgery centres, accounting for half of UK patients.
Patients:
Cohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures.
Methods:
Risk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service.
Outcome Measures:
Impact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs.
Results:
Seven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3-£17 289) to £66 784 (£40 609-£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year.
Conclusion:
Postoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.
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