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Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical
Dan-Mihai Dorobantu1,2,3, Qi Huang4, Ferran Espuny Pujol4
1Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom.
Insights
Health resource use for single ventricle heart patients significantly decreases after infancy. Early life factors impact initial hospital stays, while specific patient groups may require ongoing research for better outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Healthcare Resource Utilization
Background:
- Functionally single ventricle (FSV) heart conditions require extensive medical care from birth through adolescence.
- Understanding long-term health resource use is crucial for managing these complex pediatric cases.
Purpose of the Study:
- To comprehensively analyze health resource utilization in FSV patients from birth to 18 years.
- To identify risk factors associated with variations in healthcare needs.
Main Methods:
- Utilized linked national datasets (2000-2017) for 3037 FSV patients in England and Wales.
- Analyzed hospital and outpatient records, stratifying by age intervals.
- Employed quantile regression to explore risk factors for resource use.
Main Results:
- Hospitalization decreased significantly from the first year of life (median 60 days) to adolescence (2-9 days/year).
- First-year resource use was influenced by factors like procedure timing, specific diagnoses (e.g., hypoplastic left heart syndrome), comorbidities, and illness severity.
- Post-Fontan procedure resource use was primarily linked to early severe illness markers.
Conclusions:
- Healthcare resource use in FSV patients is highly variable, with a substantial decrease after the first year of life.
- Identified patient subsets with high initial or persistent resource needs warrant further investigation.
- Findings highlight the need for tailored management strategies based on individual patient trajectories.
Objective:
The study objective was to provide a detailed overview of health resource use from birth to 18 years old for patients with functionally single ventricles and identify associated risk factors.
Methods:
All patients with functionally single ventricles treated between 2000 and 2017 in England and Wales were linked to hospital and outpatient records using data from the Linking AUdit and National datasets in Congenital HEart Services project. Hospital stay was described in yearly age intervals, and associated risk factors were explored using quantile regression.
Results:
A total of 3037 patients with functionally single ventricles were included, 1409 (46.3%) undergoing a Fontan procedure. During the first year of life, the median days spent in hospital was 60 (interquartile range, 37-102), mostly inpatient days, mirroring a mortality of 22.8%. This decreases to between 2 and 9 in-hospital days/year afterward. Between 2 and 18 years, most hospital days were outpatient, with a median of 1 to 5 days/year. Lower age at the first procedure, hypoplastic left heart syndrome/mitral atresia, unbalanced atrioventricular septal defect, preterm birth, congenital/acquired comorbidities, additional cardiac risk factors, and severity of illness markers were associated with fewer days at home and more intensive care unit days in the first year of life. Only markers of early severe illness were associated with fewer days at home in the first 6 months after the Fontan procedure.
Conclusions:
Hospital resource use in functionally single ventricle cases is not uniform, decreasing 10-fold during adolescence compared with the first year of life. There are subsets of patients with worse outcomes during their first year of life or with persistently high hospital use throughout their childhood, which could be the target of future research.
