Abstract 13158: Excess Costs Attributable to Complications and Prolonged Length of Stay Following Congenital Heart Surgery
Background: While children’s hospitals face increasing pressure to both optimize quality and reduce costs, there are limited data regarding how to best achieve these goals for common and resource-intense conditions such as congenital heart disease. We evaluated excess costs attributable to complications and prolonged length of stay (LOS) following congenital heart surgery in a large multicenter cohort.
Methods: Clinical data from The Society of Thoracic Surgeons Database were linked to estimated costs (adjusted for region and inflation) from the Pediatric Health Information Systems Database (2006-10). Cost/case attributable to complications and prolonged LOS was modeled for 9 operations of varying complexity adjusting for patient baseline characteristics.
Results: Of 12,718 included operations (27 centers), average excess cost/case in those with any complication (vs. none) was $56,584 (+$132,483 for major complications), and varied across operations (Table). The highest cost complications were tracheostomy ($179,350), mechanical circulatory support, respiratory insufficiency, renal failure, reoperation, neurologic deficit, infection, cardiac arrest, phrenic/recurrent laryngeal nerve injury, and pleural effusion requiring drainage ($30,356). Compared to those with LOS ≤ the median, those with an additional day of LOS had an average excess cost/case of $19,273 (Table). There were significant excess costs related to complications and LOS for both high complexity and lower complexity (but more commonly performed) operations (Table).
Conclusions: Complications and prolonged LOS following congenital heart surgery are associated with significant costs. Thus, substantial savings may be possible through efforts to reduce these morbidities. While excess costs are greatest for high complexity operations, initiatives focused on lower complexity operations may also result in significant savings due to their higher prevalence.
- © 2013 by American Heart Association, Inc.