Abstract 18157: Mortality, Rehospitalizations and Costs of Congenital Heart Disease Managed Operatively in the First Year of Life
Introduction: Hospitalizations for cardiac procedures and associated readmissions are an expected part of management for many children with congenital heart disease (CHD). The full burden of these hospitalizations including readmissions and costs to the health system is unknown.
Hypothesis: Children undergoing a cardiac procedure in the first year of life experience increased mortality and rehospitalizations outside of the immediate perioperative period, quantifiable using population-based data.
Methods: A longitudinal record-linkage population-based cohort study was performed examining a twelve-year period 2001-2012, in New South Wales (NSW), Australia. Data were obtained from NSW Admitted Patient Data Collection, NSW Perinatal Data Collection and Register of Births, Deaths and Marriages. Children undergoing a cardiac procedure (surgical or catheter-based) in the first year of life were identified using procedure codes from the Australian Classification of Health Interventions.
Results: Rate of cardiac procedures in the first year of life over the study period was steady at 2.5 children per 1 000 live births, accounting for 2 722 children. Children undergoing isolated closure of a patent ductus arteriosus (n=416) were excluded from further analysis. Of the remaining 2 306 children, 50% required readmission in the first year of life, of these over 50% were unplanned. Average total cost per infant for the initial procedure admission was $67 054 AUD (95% CI $63,124 - $70,984) with a median length of stay (LOS) of 13 days (IQR 8-23). Average cost per readmission in the first year of life was $11,342 (95% CI 10,361-$12,323) with average LOS of 5.1 days. Mortality rate in the first 30 days following initial procedure was 3.1% (72/2306). Mortality rate by age 1 year was 7.1% (164/2306) and for the subgroup who had surgery in the neonatal period 13.8% (131/981).
Conclusion: The risk of mortality in operatively-managed CHD extends beyond the immediate perioperative period. Children undergoing a cardiac procedure in their first year are often readmitted to hospital for both further planned procedures and unplanned reasons such as infection. These readmissions represent the significant burden of illness and pose a substantial financial cost to the health system.
Author Disclosures: C.M. Lawley: None. S.J. Lain: None. G.A. Figtree: None. G.F. Sholler: None. D.S. Winlaw: None. C.L. Roberts: None.
- © 2016 by American Heart Association, Inc.