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Published on: July 18, 2014
Variation in hospital costs and resource utilisation after congenital heart surgery
Joshua J Blinder1, Yuan-Shung Huang2, Joseph W Rossano3
1Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
Insights
Pediatric cardiac surgery costs are rising, especially for neonates due to longer hospital stays and resource needs. These higher costs persist at 1- and 5-year follow-ups, highlighting a need for further investigation into cost drivers.
Area of Science:
- Pediatric cardiac surgery
- Health economics
- Healthcare resource utilization
Background:
- Improving survival rates in pediatric cardiac surgery are noted, but comprehensive cost data, particularly longitudinal follow-up costs, remain limited.
- Understanding the economic impact of pediatric cardiac surgery is crucial for resource allocation and healthcare planning.
Purpose of the Study:
- To estimate nationwide inpatient and longitudinal follow-up costs associated with pediatric cardiac surgery.
- To identify factors influencing hospital costs in this patient population.
Main Methods:
- A retrospective cohort study analyzed data from the Pediatric Health Information System database for children under 19 undergoing cardiac surgery.
- Patients were categorized into neonates (≤30 days), infants (31-365 days), and children (>1 year).
- Outcomes included hospital stay duration and costs at index admission and at 1- and 5-year follow-ups.
Main Results:
- The study included 99,670 patients; neonates represented 27% and incurred the highest total hospital costs.
- Despite declining mortality, inpatient costs increased by 5% annually. Neonates exhibited higher diagnosis complexity, ICU resource use, and pharmacotherapy/respiratory therapy needs.
- No association was found between hospital surgical volume and mortality or costs. Neonates had significantly higher cumulative hospital costs at 1- and 5-year follow-ups.
Conclusions:
- Inpatient costs for pediatric cardiac surgery are increasing, primarily due to extended hospital stays.
- Neonates present with greater diagnostic complexity, require more hospital resources, and incur higher costs at 1- and 5-year follow-ups compared to older children.
- Further research integrating clinical and administrative data is essential to pinpoint drivers of prolonged hospital stays and associated costs.
Background:
Children undergoing cardiac surgery have overall improving survival, though they consume substantial resources. Nationwide inpatient cost estimates and costs at longitudinal follow-up are lacking.
Methods:
Retrospective cohort study of children <19 years of age admitted to Pediatric Health Information System administrative database with an International Classification of Diseases diagnosis code undergoing cardiac surgery. Patients were grouped into neonates (≤30 days of age), infants (31-365 days of age), and children (>1 year) at index procedure. Primary and secondary outcomes included hospital stay and hospital costs at index surgical admission and 1- and 5-year follow-up.
Results:
Of the 99,670 cohort patients, neonates comprised 27% and had the highest total hospital costs, though daily hospital costs were lower. Mortality declined (5.6% in 2004 versus 2.5% in 2015, p < 0.0001) while inpatient costs rose (5% increase/year, p < 0.0001). Neonates had greater index diagnosis complexity, greater inpatient costs, required the greatest ICU resources, pharmacotherapy, and respiratory therapy. We found no relationship between hospital surgical volume, mortality, and hospital costs. Neonates had higher cumulative hospital costs at 1- and 5-year follow-up compared to infants and children.
Conclusions:
Inpatient hospital costs rose during the study period, driven primarily by longer stay. Neonates had greater complexity index diagnosis, required greater hospital resources, and have higher hospital costs at 1 and 5 years compared to older children. Surgical volume and in-hospital mortality were not associated with costs. Further analyses comprising merged clinical and administrative data are necessary to identify longer stay and cost drivers after paediatric cardiac surgery.
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