Abstract 12164: Resource Utilization and Outcomes for Infants With Hypoplastic Left Heart Syndrome vs. Tricuspid Atresia: A Multi-Institutional Study
Purpose: Advances in the management of hypoplastic left heart syndrome (HLHS) have led to a remarkable reduction in stage I mortality. We sought to characterize and identify factors associated with 1st yr. resource utilization and mortality for infants with HLHS vs. infants with tricuspid atresia (TA).
Methods: Retrospective review of all infants born with HLHS or TA (1/2005 -1/2011) using the Pediatric Health Information Systems Database (41 US children’s hospitals). Generalized linear and Cox regression analyses were performed to evaluate factors associated with resource utilization and mortality. Kaplan-Meyer survival curves were generated.
Results: Of 4201 infants, 3065 (males: 62%) had HLHS and 1146 (males: 55%) had TA (p≤0.001). The 1-year transplant-free survival (Fig. 1) was 76% (2329/3065) for HLHS and 84% (963/1146) for TA (p≤0.001). Insurance was associated with mortality for both cohorts (Table 1). Race and surgery volume were associated with mortality for HLHS. Total length of inpatient stay (LOS) for the 1st yr. was 66±60 and 44±51 days; ICU was 42±48 and 28±38 days for HLHS and TA respectively (p≤0.0001). Hospitalization charges were higher for HLHS $751,000±19,100 compared to $422,000±12,600 for TA (p≤0.0001). HLHS, Medicare/aid, non-Hispanic black, prematurity and southern region were associated with longer LOS (p≤0.05). HLHS cohort, private insurance, prematurity, and southern region were associated with higher cost (p≤0.05).
Conclusions: Despite advancements in management, 1styr mortality and resource utilization of infants with HLHS were considerably higher compared to TA. Race, insurance, and regional and center specific factors affected both mortality and cost. Addressing these disparities may be important for developing cost effective policies to improve outcomes.
- © 2013 by American Heart Association, Inc.