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Does Value Vary by Center Surgical Volume for Neonates With Truncus Arteriosus? A Multicenter Study
Joyce T Johnson1, Denise M Scholtens2, Alan Kuang2
1Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
The Annals of Thoracic Surgery
|August 10, 2020
Summary
Repairing truncus arteriosus at high-volume centers leads to better outcomes and lower costs. This value-based approach improves care for congenital heart defect patients.
Area of Science:
- Pediatric cardiology
- Congenital heart defects
- Health services research
Background:
- Truncus arteriosus is a severe congenital heart defect associated with high mortality and resource utilization.
- Value assessment, focusing on outcomes relative to cost, is crucial for enhancing care quality and reducing expenses.
- This study investigated the impact of surgical center volume on the value of truncus arteriosus repair.
Purpose of the Study:
- To determine if truncus arteriosus repair at high-volume centers offers better outcomes and lower costs compared to low-volume centers.
- To evaluate the relationship between center volume and key healthcare metrics in neonates undergoing this repair.
Main Methods:
- Retrospective analysis of a multicenter cohort of neonates with truncus arteriosus from 2004-2015.
- Utilized the Pediatric Health Information Systems database for data extraction.
- Employed multivariate regression models to assess total hospital cost, mortality, ventilation days, ICU and hospital length of stay (LOS), and inotropic agent use, adjusting for various clinical factors.
Main Results:
- High-volume centers ( >3 repairs/year) were associated with significantly lower costs (75th percentile: $28,456 less, P=.02).
- Patients at high-volume centers experienced shorter median postoperative ventilation days (5 vs 6), ICU LOS (13 vs 19 days), hospital LOS (23 vs 28 days), and inotropic agent use (3 vs 4 days) (all P<.001).
- In-hospital mortality rates did not differ significantly between high-volume and low-volume centers.
Conclusions:
- Surgical repair of truncus arteriosus at high-volume centers yields superior value due to lower costs and improved clinical outcomes.
- Value-based interventions and consideration of center volume are recommended to optimize care for truncus arteriosus.
- These findings support the centralization of complex congenital heart defect surgeries to high-volume institutions.
