Risk factors for higher cost in congenital heart operations

Area of Science:

• Pediatric Cardiology
• Health Services Research
• Medical Economics

Background:

• Hospital mortality is no longer the primary outcome measure for many congenital heart defects (CHDs).
• Excellent survival rates for CHD repair necessitate extensive perioperative hospital services, increasing care costs.
• Identifying preoperative risk factors for high costs is crucial for managed care and resource allocation.

Purpose of the Study:

• To identify preoperative risk factors associated with higher hospital costs for congenital heart defect repair.
• To enable better resource allocation and managed care contracting.

Main Methods:

• Retrospective analysis of actual hospital costs for 144 patients undergoing repair of four common CHDs (atrial septal defect, ventricular septal defect, atrioventricular canal, tetralogy of Fallot).
• Financial risk defined as high standard deviation (>60% of mean costs) indicating cost unpredictability.
• Costs were tracked within the hospital to identify sources of financial variability.

Main Results:

• Atrial septal defect repair costs were predictable and linked to length of stay.
• For ventricular septal defect repair, younger age (<6 months), longer preoperative stay (>7 days), and Down syndrome predicted higher costs.
• For atrioventricular canal repair, prolonged preoperative hospitalization (e.g., due to pneumonia/ventilation) significantly increased costs.
• For tetralogy of Fallot repair, multiple congenital anomalies, prior palliation, or severe "tet" spells were associated with higher costs.

Conclusions:

• While CHD repair survival is high, associated costs can be substantial for complex cases.
• Preoperative identification of factors predicting financial risk is feasible.
• This predictive knowledge can inform risk adjustments for managed care and strategic resource allocation.