Managing cyanotic neonates with tetralogy of Fallot: A national perspective on surgical approaches

Management of cyanotic neonates with tetralogy of Fallot (ToF) remains an important clinical challenge without Level 1 evidence. The present study employs the Healthcare Cost and Utilization Project Kids Inpatient Dataset to evaluate a national sample of neonates undergoing intervention for ToF.

A 4-stage algorithm was designed to capture records for neonates with ToF who underwent primary repair, ductal stents, and systemic-to-pulmonary shunts in the Healthcare Cost and Utilization Project Kids Inpatient Dataset (2016, 2019, and 2022). National hospitalization estimates and percent reported reflect weighted results based on survey design. Resource utilization was represented by median hospital length of stay and inflation-adjusted cost in 2023 US dollars.

An estimated 159.5 discharges were identified for primary repair, 145.3 for ductal stents, and 407.4 for surgical systemic to pulmonary shunts. An estimated 256.3 discharges were identified for infants undergoing definitive repairs following ductal stents. From 2016 to 2022, ductal stent utilization increased (linear trend P = .0011), whereas surgical shunt use decreased (trend P = .0012). There was a trend toward a decrease in primary repair (trend P= .12). Over this time frame, there was a significant increase in the median cost for ductal stent (difference, $77,252 [2023 dollars], P = .035) and surgical shunt (difference, $81,111 [2023 dollars]; P = .043) palliations and a decrease in primary repair cost (difference, $76,337 [2023 dollars]; P = .44).

This investigation demonstrated increased utilization of ductal stents for neonatal ToF across the United States. Despite this increase, changes in cost may reflect a complex paradigm shift in patient/center-specific decision making.