A. Eckhauser1, J. Marietta3, N. Pinto2, M. Puchalski2 1University Of Utah,Cardiothoracic Surgery/Surgery,Salt Lake City, UT, USA 2University Of Utah,Cardiology/Pediatrics,Salt Lake City, UT, USA 3Primary Children’s Hospital,Salt Lake City, UT, USA
Introduction: Resource utilization and the cost of caring for patients with congenital heart disease (CHD) is largely unknown and often inferred from administrative data. How these costs are broken down into components by operating room, nursing care, rooming, and pharmacy can be used to help better understand opportunities to improve care. We sought to evaluate these costs in three common congenital heart surgeries.
Methods: We evaluated overall costs for 3 common congenital heart defects- complete atrioventricular canal (AVC), coarctation of the aorta (AA) and D-transposition of the great arteries (DTGA) using linking to a statewide database (1997-2012) of inpatient discharge and vital records thru age 5. For the subset of patients operated on at our tertiary care center from 2012-2016 we obtained costs associated with the initial surgery using an activity based accounting system that broke down cost components for the index hospitalization and stratified these costs based on major comorbidities to understand resource use.
Results: The 1yr-costs for the AVC cohort were $86,271 ± 112,900 (n=213), AA $57,788 ± 84,036 (n=465) and DTGA $108,840 ± 98,768 (n=169) with an additional 18, 10, and 7% respectively added through year 5. The total average cost at our center for the initial surgical hospitalization for AVC repair was $24,318 ± 22,007, for AA $35,207 ± 32,840 and for DTGA $56,516 ± 28,427. Figure 1 displays major contributors to surgical costs and differences based on major comorbidities within each cohort for the initial surgical hospitalization. Prematurity had the most profound increase in cost in patients with DTGA. Trisomy 21 in patients with AVC actually led to a decrease in utilization.
Conclusion: The majority of hospital costs associated with caring for children with CHD occur in the first year of repair and are related to the surgical hospitalization. Risk factors such as prematurity and operative strategy can have profound effects on total cost that vary significantly by type of CHD. Using such data to explore this effect can help to identify leverage points to improve the value of care delivered to these patients.
