Trends in Resource Utilization Associated with the Inpatient Treatment of Neonatal Congenital Heart Disease

Smith, Andrew H.; Patel, Neal

doi:10.1111/chd.12103

Cited by 36 publications

(23 citation statements)

References 19 publications

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“…2, 3 These patients frequently also undergo non-cardiac surgical procedures for the management of both comorbid conditions and additional non-cardiac congenital anomalies. 4 The need for multiple major operative procedures in this population is of particular concern due to the more complicated anesthetic management and increased risk for perioperative complications. 5–12 …”

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confidence: 99%

Variability in noncardiac surgical procedures in children with congenital heart disease

Sulkowski

Cooper

McConnell

et al. 2014

Journal of Pediatric Surgery

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Background The purpose of this study was to examine the volume and variability of non-cardiac surgeries performed in children with congenital heart disease (CHD) requiring cardiac surgery in the first year of life. Methods Patients who underwent cardiac surgery by 1 year of age and had a minimum 5-year follow-up at 22 of the hospitals contributing to the Pediatric Health Information System database between 2004–2012 were included. Frequencies of non-cardiac surgical procedures by age 5 years were determined and categorized by subspecialty. Patients were stratified according to their maximum RACHS-1 (Risk Adjustment in Congenital Heart Surgery) category. The proportions of patients across hospitals who had a non-cardiac surgical procedure for each subspecialty were compared using logistic mixed effects models. Results 8,857 patients underwent congenital heart surgery during the first year of life, 3,621 (41%) of whom had 13,894 non-cardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4,432; 31.9%) or otolaryngology (4,002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having non-cardiac surgical procedures. Compared to children in the low risk group (RACHS-1 categories 1–3), children in the high-risk group (categories 4–6) were more likely to have general, dental, orthopedic, and thoracic procedures. Conclusions Children with CHD requiring cardiac surgery frequently also undergo non-cardiac surgical procedures; however, considerable variability in the frequency of these procedures exists across hospitals. This suggests a lack of uniformity in indications used for surgical intervention. Further research should aim to better standardize care for this complex patient population.

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Variability in noncardiac surgical procedures in children with congenital heart disease

Sulkowski

Cooper

McConnell

et al. 2014

Journal of Pediatric Surgery

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“…We were also able to assess complications specific to congenital heart surgery. [3][4][5][6][7] Standardized information collected across hospitals within the PHIS Database allowed calculation of total hospital costs, which better estimate the resources consumed to carry out the service provided, compared with charge data reported in previous studies, which only reflect what the hospital billed for a service, may vary across hospitals, and overestimate cost. 6,7 These types of data linkages can maximize the strengths and mitigate the weaknesses of each data set, and allow for analyses not possible within each individual data set alone.…”

Section: Discussionmentioning

confidence: 99%

“…3,7 Further studies are needed to provide additional insight into other factors, such as potential differences in use of laboratory testing and imaging. 4 In addition, resource use can be assessed through a variety of different methods, each of which are associated with certain strengths and limitations. We used standard methodology involving cost-to-charge ratios.…”

Section: Figurementioning

confidence: 99%

“…Previous studies have been limited by the use of administrative data sets and inherent difficulties related to case ascertainment and risk adjustment, such that there are limited data available to hospitals, payers, and policymakers regarding average costs for the most common operations, the range of costs across institutions, and potential mechanisms underlying any variation identified. [3][4][5][6][7][8] This information has become increasingly important in an era of rising health care expenditures, where recent initiatives aim to provide hospitals with incentives to both improve quality of care and reduce costs. 9 A better understanding of factors impacting hospital costs for common and resource-intense conditions such as congenital heart disease is critical to the successful design and implementation of such initiatives.…”

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Variation in Congenital Heart Surgery Costs Across Hospitals

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Congenital heart disease is known to be a commonly treated and resource-intense condition across children' s hospitals, yet knowledge regarding the degree of cost variation across hospitals and associated factors is lacking.WHAT THIS STUDY ADDS: Using a linked clinical and administrative data set, we establish benchmarks for hospital costs for common congenital heart operations, and demonstrate wide variation in cost between hospitals related in part to differences in length of stay and complications. abstract BACKGROUND: A better understanding of costs associated with common and resource-intense conditions such as congenital heart disease has become increasingly important as children' s hospitals face growing pressure to both improve quality and reduce costs. We linked clinical information from a large registry with resource utilization data from an administrative data set to describe costs for common congenital cardiac operations and assess variation across hospitals. METHODS:Using linked data from The Society of Thoracic Surgeons and Pediatric Health Information Systems Databases (2006Databases ( -2010, estimated costs/case for 9 operations of varying complexity were calculated. Between-hospital variation in cost and associated factors were assessed by using Bayesian methods, adjusting for important patient characteristics. RESULTS:Of 12 718 operations (27 hospitals) included, median cost/ case increased with operation complexity (atrial septal defect repair, [$25 499] to Norwood operation, [$165 168]). Significant betweenhospital variation (up to ninefold) in adjusted cost was observed across operations. Differences in length of stay (LOS) and complication rates explained an average of 28% of between-hospital cost variation. For the Norwood operation, high versus low cost hospitals had an average LOS of 50.8 vs 31.8 days and a major complication rate of 50% vs 25.3%. High volume hospitals had lower costs for the most complex operations.CONCLUSIONS: This study establishes benchmarks for hospital costs for common congenital heart operations and demonstrates wide variability across hospitals related in part to differences in LOS and complication rates. These data may be useful in designing initiatives aimed at both improving quality of care and reducing cost. Pediatrics 2014;133:e553-e560 AUTHORS:

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“…Paediatric patients with congenital heart disease (CHD) frequently undergo noncardiac surgical procedures for the management of both comorbidities and additional congenital anomalies [40]. Spinal anaesthesia is also used for noncardiac surgery in these paediatric patients.…”

Section: Figurementioning

confidence: 99%

Spinal Anaesthetic Management in Paediatric Surgery

Caliskan¹

2017

Pediatric and Neonatal Surgery

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The first paediatric cases involving the use of spinal anaesthesia were published at the end of the nineteenth century. However, the technique did not receive much interest in paediatric anaesthesia until the 1980s. In the last three decades, paediatric spinal anaesthesia has received widespread approval as an alternative technique to general anaesthesia in school-/preschool-aged children, particularly in term and preterm neonates with high risk associated with general anaesthesia. The development of new and safer local anaesthetics mainly through better understanding of the pharmacokinetics and dynamics and dedicated paediatric tools are the keys to this success. Paediatric spinal anaesthesia is an easy and effective technique, and its high efficiency and safety are supported by the presence of numerous publications from the medical literature. However, it remains limited to situations in which general anaesthesia poses a major risk. Despite these advances, it is important to understand the correct technique and the anatomy of children at different ages. Also, the appropriate equipment, the pharmacokinetics and toxicities of local anaesthetics and the indications and complications of paediatric regional blocks should be well known. The goal of this chapter is to review and discuss some of these topics of paediatric spinal anaesthesia for paediatric surgery.

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Trends in Resource Utilization Associated with the Inpatient Treatment of Neonatal Congenital Heart Disease

Cited by 36 publications

References 19 publications

Variability in noncardiac surgical procedures in children with congenital heart disease

Variability in noncardiac surgical procedures in children with congenital heart disease

Variation in Congenital Heart Surgery Costs Across Hospitals

Spinal Anaesthetic Management in Paediatric Surgery

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