Admission to a Dedicated Cardiac Intensive Care Unit Is Associated With Decreased Resource Use for Infants With Prenatally Diagnosed Congenital Heart Disease

Abstract

Many factors in the delivery and perinatal care of infants with a prenatal diagnosis of congenital heart disease (CHD) have an impact on outcome and costs. This study sought to determine the modifiable factors in perinatal management that have an impact on postnatal resource use for infants with CHD. The medical records of infants with prenatally diagnosed CHD (August 2006-December 2011) who underwent cardiac surgery before discharge were reviewed. The exclusion criteria ruled out prematurity and intervention or transplantation evaluation before surgery. Clinical characteristics, outcomes, and cost data were collected. Multivariate linear regression models were used to determine the impact of perinatal decisions on hospitalization cost and surrogates of resource use after adjustment for demographic and other risk factors. For the 126 patients who met the study criteria, the median hospital stay was 22 days (range 4-122 days), and the median inflation-adjusted total hospital cost was $107,357 (range $9,746-602,320). The initial admission to the neonatal versus the cardiac intensive care unit (NICU vs. CICU) was independently associated with a 19 % longer hospital stay, a 26 % longer ICU stay, and 47 % more mechanical ventilation days after adjustment for Risk Adjustment for Congenital Heart Surgery, version 1 score, gestation age, genetic abnormality, birth weight, mode of delivery, and postsurgical complications. Weekend versus weekday delivery was not associated with hospital cost or length of hospital stay. For term infants with prenatally diagnosed CHD undergoing surgery before discharge, preoperative admission to the NICU (vs. the CICU) resulted in a longer hospital stay and greater intensive care use. Prenatal planning for infants with CHD should consider the initial place of admission as a modifiable factor for potential lowering of resource use.

Resource use in neonatal cardiac surgery: Lacking details

“…Johnson and colleagues 5 found that 39% of neonates were admitted to the CICU, 48% to the NICU, and 13% to the PICU. Consistent with the findings of their previous work, 4 they found that admission to the CICU was associated with a significant cost reduction when compared with admission to the NICU. Further, admission to the CICU was associated with a shorter LOS and fewer days of mechanical ventilation.…”

“…2,3 Further, admission to a dedicated cardiac intensive care unit (CICU) was found to be associated with decreased resource use in a single-institution study. 4 Johnson and colleagues, 5 the same group that conducted that earlier study, 4 report in this edition of the Journal a confirmation of their initial findings with a multicenter study of data from the Pediatric Hospital Information Systems (PHIS) database.…”

“…Johnson and colleagues 5 used the PHIS database to determine the possibility of 2 associations in the setting of neonatal cardiac surgery: (1) association of intensive care unit admission location with hospital costs and resource use and (2) association of intensive care unit admission location with mortality. Although not explicitly stated, their hypotheses appear to be related to their initial single-center findings 4 that at least the first association exists nationwide. With data from the PHIS database and cardiac surgical procedure codes, they were able to identify neonates (<30 days of age) with a Risk Adjusted Classification for Congenital Heart Surgery score of 2 through 6 undergoing cardiac surgery from January 2004 through December 2013 to include in their study (n ¼ 19,984 neonates).…”

Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease

“…9,26,27 The advantages of in utero transportation vs postnatal transportation of infants with CHD, including maternal and neonatal safety and costs, vary according to the obstetric and pediatric resources of a specific region. 31 Finally, a prospective multicenter study showed that postnatal diagnosis of CHD was associated with higher costs, compared to those with prenatal diagnosis, due to the need for emergency transportation. 24,28,29 Recent studies have investigated the costs of specialized delivery and early postnatal management in pregnancies complicated by fetal CHD.…”

“…In another retrospective study, prenatally diagnosed infants with CHD admitted to the cardiac intensive care unit (ICU) compared to those admitted to the neonatal ICU had shorter length of stay, less mechanical ventilation, and lower costs of care. 31 Finally, a prospective multicenter study showed that postnatal diagnosis of CHD was associated with higher costs, compared to those with prenatal diagnosis, due to the need for emergency transportation. 32 While these results suggest that prenatal diagnosis of CHD and management in the proper ICU setting can potentially reduce healthcare costs for these conditions, further studies investigating this topic are needed.…”