Abstract 9473: Quantifying the Impact of Early Term Gestation Delivery Upon Resource Demands Following Neonatal Congenital Heart Surgery
Background: Evidence suggests inferior outcomes among term neonates with serious congenital heart disease delivered at 37 through 38 weeks (early term) gestation compared to their term (39 through 40 weeks) gestation counterparts. We sought to quantify the impact of an early term gestation delivery upon resource demands following neonatal congenital heart surgery.
Methods and Results: We queried The Pediatric Health Information System administrative database for all neonates delivered at term gestation (37 through 40 weeks) undergoing congenital heart surgery at less than 31 days of age from January 2009 through December 2012 classified by the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system. Patients with absent financial data were excluded from consideration. Financial data were adjusted for 2012 dollars. Of 5139 patients meeting inclusion criteria, median birthweight was 3.2 kg (interquartile range [IQR] 2.9-3.5), 60% were male, and 41% were delivered at an early term gestation. Perioperative morbidities more common among early term gestation infants included gastroesophageal reflux (21% v. 17%, p=0.002), acute kidney injury (13% v 11%, p=0.03), and pacemaker placement (1.7% v. 0.9%, p=0.02). Postoperative length of stay was longer among early term gestation infants (18 v. 14 days, p<0.001), with a trend toward higher operative mortality among early term gestation infants in a univariate analysis (7.8% v. 6.4%, p=0.06). Multivariate regression demonstrated that independent of perioperative covariates including birthweight, low center volume, RACHS 6 classification, diagnosis of a genetic syndrome, and government payor class, each early term gestation delivery was associated with a $35748 increase in hospital charges (95%CI $2692-$68803, p=0.034) and a $14118 increase in total estimated hospital cost (95%CI $754-$27482, p=0.038).
Conclusions: We demonstrate and quantify significant and independent increases in resource use among early term gestation infants undergoing congenital heart surgery. Together with existing literature, our findings support the avoidance of elective early term delivery in the setting of prenatally diagnosed congenital heart disease requiring operative interventions in the neonatal period.
Author Disclosures: A.H. Smith: None. D.A. Parra: None. B.A. Mettler: None. D.P. Bichell: None. A. Kavanaugh-McHugh: None.
- © 2014 by American Heart Association, Inc.