Abstract 18011: The Impact of Institutional Stage I Surgical Volume on Mortality, Length of Stay, and Hospital Charges in Infants With Hypoplastic Left Heart Syndrome, a Review of the Texas Inpatient Public Use Data File From 1999-2012
OBJECTIVE: Studies to date have suggested an association between center surgical volume and lower mortality in children undergoing heart surgery. While this has been investigated in national sampled data and registries, contemporary statewide data specifically relevant to public health insurance have not been investigated in detail.
METHODS: The Texas Inpatient Public Use Data File, a database of hospital discharges in the state of Texas, was queried from 1999-2012. Infants with the diagnosis of HLHS undergoing a Stage I Palliation (S1P) as defined by an aortopulmonary shunt (ICD-9 39.0) or right ventricle to pulmonary artery conduit (35.92) were included. Univariable and multivariable analyses were used to investigate the relationship between center S1P surgical volume and hospital mortality, length of stay, and total charges. The association between insurance status and race/ethnicity and mortality were also investigated.
RESULTS: Of >37 million discharges, 780 infants with HLHS underwent S1P at 14 hospitals. The mean number of annual S1Ps at each hospital varied from <1 to 16.1 with 53% of infants undergoing surgery at a center with >15 S1Ps/year. Fifty-four percent of the infants were covered by public insurance. In univariable analysis, lower surgical volume was associated with increased mortality, with mortality in hospitals performing <5 surgeries per year 30.6%, 5-15 surgeries per year 27.1%, and >15 surgeries per year 15.6% (p for trend<0.001). Higher surgical volume was not associated with length of stay (Rho=0.004) or total charges (Rho=0.057). In multivariable analysis, adjusting for discharge year and preterm birth, lower surgical volume remained associated with increased mortality (compared to >15 surgeries/year, <5/year 2.62, 95%CI 1.78-3.85, 5-15/year 2.44, 95%CI 1.40-4.28). No categories of race/ethnicity or insurance status were associated with increased mortality.
CONCLUSION: Institutions with higher Stage I surgical volume had lower HLHS hospital mortality, without increased charges or length of stay. Given the large population of infants covered by public insurance, governmental health care plan support of regionalization of care in neonatal HLHS has the potential to improve mortality rates in this population.
- © 2013 by American Heart Association, Inc.