Abstract 17406: Association of Post-operative Complications with Clinical Outcomes and Hospital Costs following the Norwood Operation
Introduction: Patients undergoing the Norwood operation consume considerable healthcare resources. However, data are limited regarding factors impacting hospitalization costs for these patients. We evaluated the association of post-operative complications with hospital costs.
Methods: We utilized a unique dataset consisting of prospectively collected clinical outcomes and complications data from the Pediatric Heart Network Single Ventricle Reconstruction trial linked at the patient level with cost data for hospitals (n=10) participating in the Children’s Hospital Association administrative databases during the trial period. Probabilistic matching of indirect identifiers was used to link records. Cost-to-charge ratios were used to estimate costs, which were adjusted for regional differences and inflation. The relationship between complications and cost was modeled using linear regression, accounting for the skewed distribution of cost, and adjusting for within-center clustering and patient characteristics.
Results: A total of 334 eligible Norwood records (95%) were matched between datasets. Overall, 82% suffered at least one complication (median 2; range 0-33). The most common complications associated with increased hospital costs included: cardiopulmonary resuscitation (22%), arrhythmia (22%), sepsis (15%), and extracorporeal membrane oxygenation (11%). Those with complications had longer post-operative length of stay (25d vs. 12d, p<0.0001), more total ventilator days (7d vs. 5d, p<0.0001), and higher in-hospital mortality (17.6% vs. 3.4%, p<0.01). Adjusted hospital costs in those with a complication were $113,505 (95% CI $99,326 - $129,707) vs. $71,453 (95% CI $59,200 - $86,243) in those without a complication, p=0.0001, and costs increased with the number of complications (1-2 complications = $117,137 vs. 3-4 complications = $155,500 [p<0.01] vs. ≥5 complications $266,386 [p< 0.0001]).
Conclusions: This unique dataset of merged clinical trial and cost data demonstrated that postoperative complications are common following the Norwood operation and are associated with worse clinical outcomes and higher costs. Efforts to reduce complications in this population may lead to both improved outcomes and cost savings.
Author Disclosures: K.E. McHugh: None. S.K. Pasquali: None. M.A. Hall: None. M.A. Scheurer: None.
- © 2014 by American Heart Association, Inc.