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Costs and results of cardiac operations in infants less than 4 months old. Are they worthwhile?
Insights
Pediatric cardiac surgery for infants under 4 months shows high initial mortality but most survivors achieve good health. Lower weight at operation increases mortality risk but doesn't impact long-term outcomes or costs significantly.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Health Economics
Background:
- Infants under 4 months undergoing cardiac surgery represent a high-risk population.
- Understanding outcomes and costs is crucial for optimizing care and resource allocation.
Purpose of the Study:
- To review the results and total hospital costs of nonductal cardiac procedures in infants under 4 months.
- To identify factors influencing mortality, cure rates, long-term health, and hospital costs.
Main Methods:
- Retrospective review of case histories for 220 infants undergoing 265 nonductal cardiac procedures.
- Analysis of operative mortality, survival rates, functional outcomes, and hospital costs.
- Statistical evaluation of factors including age, weight, gestational age, and type of operation.
Main Results:
- Initial operative mortality was 20%. Lower operative weight was associated with higher mortality.
- 80% of survivors had optimized general health, with 29% having normal cardiac function and 17% cured.
- Longer preoperative hospital stay and lower operative weight correlated with higher hospital costs.
- Mortality, cure, and normal function were not significantly related to gestational age, birth weight, or age at operation.
Conclusions:
- Despite significant initial mortality, most infants undergoing cardiac surgery under 4 months achieve good long-term health outcomes.
- Lower birth weight is linked to curable lesions and better long-term normalcy.
- Intensive cardiovascular care for this population is justified due to favorable survival and health outcomes.
Abstract:
From 1979 through 1983, 328 of 1,388 pediatric cardiac operations involved patients undergoing their first procedure at less than 4 months of age. Of these, 220 patients had 265 nonductal procedures, and their case histories are reviewed for results and total hospital cost. Initial operative mortality was 20% (43 patients). Infants with lower operative age and operative weight tended to have closed procedures. Mortality and cure were not related to gestational age, birth weight, age at operation, number of operations, or type of operation. Lower operative weight was associated with a greater mortality. Evaluated survivors (142 patients) were followed for a mean of 24 months. Fifteen percent (33 patients) died during follow-up. Of survivors, 80% (114 patients) had optimized general health; a subset of 29% had normal cardiac function, and 17% were cured. Lower birth weight was associated with curable lesions and normalcy (p less than 0.04). Longer preoperative hospital stay and lower weight at operation were associated with higher hospital cost (p less than 0.05). Hospital cost was not related to type of operation, gestational age, birth weight, age at operation, mortality, cure, or normalcy. Acquired neurologic dysfunction and long-term disability were uncommon. The mean hospital cost for surviving infants was +80,000 (1984 dollars). Effective hospital cost per survivor was +110,000. Mortality, cure, and normal function after cardiac operations in infants less than 4 months of age were not related to gestational age, birth weight, or age at operation. Mortality was higher in patients with a lower weight at operation. Separation into distinct fiscal cost groups is not reasonable in this series. Because most survivors are in normal or optimized cardiac health, intensive cardiovascular care in this population is justified.