Abstract 21534: Comparative Assessment of Outcomes of Corrective Surgery for Congenital Heart Disease in Adult vs. Pediatric Hospitals
Introduction: Improved surgical care has resulted in an increasing number of children with congenital heart disease (CHD) surviving to adulthood, that often require further surgery for CHD. There is controversy regarding the optimal setting to address the surgical needs of these patients. We hypothesized that adults with CHD would be best served in a pediatric hospital (PH).
Methods: Data from the Nationwide Inpatient Sample from 1998-2007 were analyzed for adults (18-64 yrs) with CHD specific ICD-9-CM diagnostic and procedure codes. Multivariable logistic regression models were used to estimate in-hospital mortality rates in PH and adult hospitals (AH) while controlling for demographics, Elixhauser comorbidity index, individual heart defects, and hospital characteristics. Secondary outcomes included length of stay and hospital charges.
Results: There were 9506 patients who underwent surgery; 9,124 at an AH and 482 at a PH. The great majority of procedures performed at AH were for aortic valve disease (76%) compared to PH (24%). Patients at AH were more likely to be older (mean age 45 yrs), male, have private insurance, have > 2 non-cardiac co-morbid conditions, and required urgent surgery. In contrast, patients at PH were younger (mean age 27 yrs), females, have public insurance and more likely to have > 2 cardiac diagnoses (29% vs.7%), and have routine admission for surgery. With increasing age the number of cardiac and non-cardiac co-morbidities increased (p <.001) and the number of distinct heart defects decreased (p <.001). Overall the risk of death was lower in PH, adjusted risk ratio (ARR) 0.4 (95% CI 0.17-0.94). Risk of death was lowest at PH for younger adults (18-24 yrs old), ARR 0.13, (95 % CI 0.05-0.35). However, for patients over age 50, surgery at PH carried a higher risk, ARR 8.98, (95% CI 2.5-32.8). There was no statistical difference in length of stay between hospitals. Hospital charges were less at AH (p = .007)
Conclusions: Younger adults with CHD have a survival benefit when cared for in a PH, compared to the older adults with CHD, who do better when cared for at AH.
- © 2010 by American Heart Association, Inc.