Abstract 13177: Long-term Outcome of Pre Versus Postnatally Diagnosed Transposition of the Great Arteries: The Feasibility of Linking Birth Defect Registry Data to Electronic Health Records
Prenatal diagnosis of transposition of the great arteries (TGA) has been shown to decrease perioperative morbidity but little data exists on its impact on long-term outcome or costs. Linking the Utah Birth Defects Network (UBDN, a statewide surveillance system) and the Utah Population Database (UPDB, statewide inpatient discharge abstracts and charges) allows infant encounters to be tracked longitudinally even when the ICD-9-CM encounter codes are unrelated to their congenital heart disease (CHD). We sought to determine differences in longitudinal medical encounters and inpatient costs for prenatally (predx) and postnatally diagnosed (postdx) TGA cases.
TGA cases identified at the UBDN (born 1997 - 2009) were reviewed and complex CHD and preterm gestation excluded. Linkages to the UPDB identified inpatient encounters, lengths of stay (LOS), associated diagnosis and procedures, and charges for cases (through 12/2011) and their mothers (10 months prior to birth). Charge data was adjusted to 2011 using the Consumer Price Index and cost/charge ratio. We used generalized linear regression with gamma distribution and log link function to compare costs and adjust for demographic and clinical risk factors. Survival and inpatient encounters between groups were compared, adjusting for risk factors using multivariate modeling.
Of 108 cases identified, 12 (11%) were prenatally diagnosed. Predx were similar to postdx in gestational age (38.6 vs 38.8 wks), birth wt <2.5 kg (0% vs 4%, p=.62) and additional congenital defects (8% vs 10%, p=.39). Death occurred in 7 cases (6%) with no difference in survival between groups (mean follow up 7.4 yrs). Predx cases had similar hospitalizations (median 2 in both groups), but higher total LOS (23d vs 19d, p<.004) as well as higher costs for both mothers ($8200 vs $5200) and index cases ($290,000 vs $151,000) after adjusting for gestational age, birth wt and additional congenital defects (p=.001).
Predx TGA cases had longer hospitalizations even after adjusting for available risk factors. Both mothers and infants in the predx group had higher longitudinal inpatient medicals costs. Ongoing investigation should explore specific cost components responsible including additional testing, surgical delays and other risk factors.
- © 2012 by American Heart Association, Inc.