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Adult congenital heart surgery in pediatric hospitals used substantial resources

Kim YY. Circ Cardiovasc Qual Outcomes. 2011;doi:10.1161/CIRCOUTCOMES.111.963223.

Issue: January 2012

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Congenital heart surgery performed on adults in pediatric hospitals used a substantial amount of resources in those facilities, according to recent results.

Moreover, those high-resource surgeries were linked to increased mortality rates compared with surgeries that were less resource-intensive.

Adult congenital heart surgery admissions and data from 45 pediatric hospitals were collected from 2000 to 2008. To identify risk factors for high resource use, researchers performed multivariable analyses using generalized estimating equations and defined “high resource use admissions as those exceeding the 90th percentile for total hospital charges.”

Overall, 3.1% of congenital heart surgery admissions to pediatric hospitals were adults, and the threshold for high resource use of total hospital charges was at least $213,803. Thirty-nine hospitals performed adult congenital heart surgery with median surgery admission charges of $88,759 (interquartile range, $63,339 to $134,482) vs. $92,529 (interquartile range, $56,191 to $188,748) for pediatric congenital heart surgery admissions. “The 90th percentile threshold for total hospital charges defining high resource use admissions was $213,803,” according to study results. High resource use had median total charges of $299,901 vs. $82,738 for non-high resource use admissions.

Congenital heart surgery admissions counted for 34% of charges, whereas high resource use admissions comprised 10% of admissions. Mortality rate for high resource use was 16% vs. 0.7% for others (P<.001), and a multivariable analysis showed higher case complexity in risk category 2 (adjusted OR=3.6; P=.02), risk category 3 (adjusted OR=13.7; P<.001), and risk category 4 and higher (adjusted OR=30.7; P<.001) vs. risk category 1. Risk factors for high resource use include DiGeorge syndrome (adjusted OR=4.2; P=.006), depression (adjusted OR=3.1; P<.001), weekend admission (adjusted OR=2.6; P<.001), and government insurance (adjusted OR=2.0; P<.001).

Disclosures: The researchers report no relevant financial disclosures.

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