Resource Use Among Adult Congenital Heart Surgery Admissions in Pediatric Hospitals

Kim, Yuli Y.; Gauvreau, Kimberlee; Bacha, Emile A.; Landzberg, Michael J.; Benavidez, Oscar J.

doi:10.1161/circoutcomes.111.963223

Cited by 54 publications

(10 citation statements)

References 42 publications

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“…In addition, CHD patients continue having procedures at pediatric hospitals into adulthood and are less likely to be lost to follow-up when they have more severe CHD requiring CHD-related hospitalizations early in life. 29–31 Furthermore, this cohort only includes data from roughly half the institutions currently included in PHIS, which may limit the generalizability of the results. In order to capture all of the procedures for each patient in the cohort, we included only hospitals that submitted both inpatient and ambulatory surgery data during our study period.…”

Section: Discussionmentioning

confidence: 99%

Variability in noncardiac surgical procedures in children with congenital heart disease

Sulkowski

Cooper

McConnell

et al. 2014

Journal of Pediatric Surgery

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Background The purpose of this study was to examine the volume and variability of non-cardiac surgeries performed in children with congenital heart disease (CHD) requiring cardiac surgery in the first year of life. Methods Patients who underwent cardiac surgery by 1 year of age and had a minimum 5-year follow-up at 22 of the hospitals contributing to the Pediatric Health Information System database between 2004–2012 were included. Frequencies of non-cardiac surgical procedures by age 5 years were determined and categorized by subspecialty. Patients were stratified according to their maximum RACHS-1 (Risk Adjustment in Congenital Heart Surgery) category. The proportions of patients across hospitals who had a non-cardiac surgical procedure for each subspecialty were compared using logistic mixed effects models. Results 8,857 patients underwent congenital heart surgery during the first year of life, 3,621 (41%) of whom had 13,894 non-cardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4,432; 31.9%) or otolaryngology (4,002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having non-cardiac surgical procedures. Compared to children in the low risk group (RACHS-1 categories 1–3), children in the high-risk group (categories 4–6) were more likely to have general, dental, orthopedic, and thoracic procedures. Conclusions Children with CHD requiring cardiac surgery frequently also undergo non-cardiac surgical procedures; however, considerable variability in the frequency of these procedures exists across hospitals. This suggests a lack of uniformity in indications used for surgical intervention. Further research should aim to better standardize care for this complex patient population.

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Section: Discussionmentioning

confidence: 99%

Variability in noncardiac surgical procedures in children with congenital heart disease

Sulkowski

Cooper

McConnell

et al. 2014

Journal of Pediatric Surgery

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“…High resource use (HRU) was defined as >90th percentile of all (ACHD and noncongenital combined) HF total charge distribution. Using this threshold, HRU has been observed in patients with ACHD undergoing surgery in pediatric hospitals and linked to increased mortality 13. High‐volume ACHD centers are more likely to care for complex patients and undertake procedures that directly influence health outcomes.…”

Section: Methodsmentioning

confidence: 99%

Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Burchill

Gao

Kovacs

et al. 2018

JAHA

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BackgroundThis study assessed trends in heart failure (HF) hospitalizations and health resource use in patients with adult congenital heart disease (ACHD).Methods and ResultsThe Nationwide Inpatient Sample was used to compare ACHD with non‐ACHD HF hospitalization and health resource trends. Health resource use was assessed using total hospital charges, hospital length of stay, and procedural burden. A total of 87 175±2676 ACHD‐related HF hospitalizations occurred between 1998 and 2011. During this time, ACHD HF hospitalizations increased 91% (4620±438–8809±740, P<0.0001) versus a 21% increase in non‐ACHD HF hospitalizations (P=0.003). ACHD HF hospitalization was associated with longer length of stay (ACHD HF versus non‐ACHD HF, 7.2±0.09 versus 6.8±0.02 days; P<0.0001), greater procedural burden, and higher charges ($81 332±$1650 versus $52 050±$379; P<0.0001). ACHD HF hospitalization charges increased 258% during the study period ($26 533±$1816 in 1998 versus $94 887±$8310 in 2011; P=0.0002), more than double that for non‐ACHD HF (P=0.04). Patients with ACHD HF hospitalized in high‐volume ACHD centers versus others were more likely to undergo invasive hemodynamic testing (30.2±0.6% versus 20.7±0.5%; P<0.0001) and to receive cardiac resynchronization/defibrillator devices (4.7±0.3% versus 1.8±0.2%; P<0.0001) and mechanical circulatory support (3.9±0.2% versus 2.4±0.2%; P<0.0001).Conclusions ACHD‐related HF hospitalizations have increased dramatically in recent years and are associated with disproportionately higher costs, procedural burden, and health resource use.

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“…Compared with other adults with CHD, the single-ventricle population has increased frequency of inpatient and outpatient visits, earlier mortality, and a relatively higher percentage of health resource use (46,47). HF or “Fontan circulatory failure” manifests differently than typical adult HF, is increasingly recognized by the second decade of life, and is often accompanied by diastolic hemodynamic abnormalities.…”

Section: Prevalence and Risk Factor-related Outcomes In Coarctation Omentioning

confidence: 99%

Emerging Research Directions in Adult Congenital Heart Disease

Gurvitz

Burns

Brindis

et al. 2016

Journal of the American College of Cardiology

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Congenital heart disease (CHD) is the most common birth defect, affecting about 0.8% of live births. Advances in recent decades have allowed >85% of children with CHD to survive to adulthood, creating a growing population of adults with CHD. Little information exists regarding survival, demographics, late outcomes, and comorbidities in this emerging group, and multiple barriers impede research in adult CHD (ACHD). The National Heart, Lung, and Blood Institute and the Adult Congenital Heart Association convened a multidisciplinary Working Group to identify high-impact research questions in ACHD. This report summarizes the meeting discussions in the broad areas of CHD-related heart failure, vascular disease and multisystem complications. High-priority subtopics identified included heart failure in tetralogy of Fallot, mechanical circulatory support/transplantation, sudden cardiac death, vascular outcomes in coarctation of the aorta, late outcomes in single ventricle disease, cognitive and psychiatric issues, and pregnancy.

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Resource Use Among Adult Congenital Heart Surgery Admissions in Pediatric Hospitals

Cited by 54 publications

References 42 publications

Variability in noncardiac surgical procedures in children with congenital heart disease

Variability in noncardiac surgical procedures in children with congenital heart disease

Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Emerging Research Directions in Adult Congenital Heart Disease

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