H. L. Short1, A. Savinkina1, R. M. Patel2, M. V. Raval1 1Emory University School Of Medicine,Pediatric Surgery,Atlanta, GA, USA 2Emory University School Of Medicine,Neonatology,Atlanta, GA, USA
Introduction: Newborns undergoing surgery represent one of the most fragile patient populations and require specialized care. Our purpose was to examine trends in neonatal surgical outcomes between children’s and non-children’s hospitals (CH and NCH).
Methods: A cross-sectional, retrospective review of the 2000, 2003, 2006, 2009 and 2012 Kid’s Inpatient Database (KID) was performed to identify all neonatal surgical cases of necrotizing enterocolitis (NEC), patent ductus arteriosis (PDA), esophageal atresia/tracheoesophageal fistula (EA/TEF), congenital diaphragmatic hernia (CDH), and gastroschisis/omphalocele (GAS/OMP). Mortality rates, length of stay (LOS) and hospital costs at CH and NCH were compared.
Results: We identified 48,149 patients who underwent a surgical procedure to correct one of the diagnoses of interest during the neonatal period. During the 12-year study period the incidence of all diagnoses increased. The majority of patients (73%) were treated at NCH, however the proportion of children treated at CH increased 12%, from 18.4% to 30.3%, during the study period. Overall mortality decreased from 14.9% in 2000 to 12.6% in 2012. This improvement is largely due to an improvement in mortality at CH from 17.2% in 2000 to 10.9% in 2012, while mortality in NCH remained stable at about 14% (Figure). Mortality was consistently lower at CH than NCH for 4 of 5 diagnoses, excluding NEC for all study years and CDH in 2006. From 2000 to 2012, overall mean LOS increased from 44 to 57 days and this trend was similar in CH and NCH. However, when individual diagnoses were examined LOS was longer in CH than NCH every year for all diagnoses except PDA. After adjustment for inflation, there was a two-fold increase in cost per day for all diagnoses from $5,015/day in 2000 to $10,508 in 2012. Cost per day was higher for each diagnosis at CH compared to NCH in each year. In 2000 these neonatal conditions cost $1.2 billion (22% at CH) and in 2012 cost increased to $7.6 billion (35% at CH).
Conclusion: Mortality among neonates undergoing surgery is improving at CH and is stable at NCH. However, LOS and costs are consistently higher at CH than NCH. In order to optimize outcomes and contain costs for these fragile patients the observed trends warrant further investigation.
