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Excess costs associated with complications and prolonged length of stay after congenital heart surgery.

Publication ,  Journal Article
Pasquali, SK; He, X; Jacobs, ML; Shah, SS; Peterson, ED; Gaies, MG; Hall, M; Gaynor, JW; Hill, KD; Mayer, JE; Li, JS; Jacobs, JP
Published in: Ann Thorac Surg
November 2014

BACKGROUND: While there is an increasing emphasis on both optimizing quality of care and reducing health care costs, there are limited data regarding how to best achieve these goals for common and resource-intense conditions such as congenital heart disease. We evaluated excess costs associated with complications and prolonged length of stay (LOS) after congenital heart surgery in a large multicenter cohort. METHODS: Clinical data from The Society of Thoracic Surgeons Database were linked to estimated costs from the Pediatric Health Information Systems Database (2006 to 2010). Excess cost per case associated with complications and prolonged LOS was modeled for 9 operations of varying complexity adjusting for patient baseline characteristics. RESULTS: Of 12,718 included operations (27 centers), average excess cost per case in those with any complication (versus none) was $56,584 (+$132,483 for major complications). The 5 highest cost complications were tracheostomy, mechanical circulatory support, respiratory complications, renal failure, and unplanned reoperation or reintervention (ranging from $57,137 to $179,350). Patients with an additional day of LOS above the median had an average excess cost per case of $19,273 (+$40,688 for LOS 4 to 7 days above median). Potential cost savings in the study cohort achievable through reducing major complications (by 10%) and LOS (by 1 to 3 days) were greatest for the Norwood operation ($7,944,128 and $3,929,351, respectively) and several other commonly performed operations of more moderate complexity. CONCLUSIONS: Complications and prolonged LOS after congenital heart surgery are associated with significant costs. Initiatives able to achieve even modest reductions in these morbidities may lead to both improved outcomes and cost savings across both moderate and high complexity operations.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

November 2014

Volume

98

Issue

5

Start / End Page

1660 / 1666

Location

Netherlands

Related Subject Headings

  • United States
  • Respiratory System
  • Postoperative Complications
  • Male
  • Length of Stay
  • Infant
  • Humans
  • Hospital Costs
  • Heart Defects, Congenital
  • Female
 

Citation

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Chicago
ICMJE
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Pasquali, S. K., He, X., Jacobs, M. L., Shah, S. S., Peterson, E. D., Gaies, M. G., … Jacobs, J. P. (2014). Excess costs associated with complications and prolonged length of stay after congenital heart surgery. Ann Thorac Surg, 98(5), 1660–1666. https://doi.org/10.1016/j.athoracsur.2014.06.032
Pasquali, Sara K., Xia He, Marshall L. Jacobs, Samir S. Shah, Eric D. Peterson, Michael G. Gaies, Matthew Hall, et al. “Excess costs associated with complications and prolonged length of stay after congenital heart surgery.Ann Thorac Surg 98, no. 5 (November 2014): 1660–66. https://doi.org/10.1016/j.athoracsur.2014.06.032.
Pasquali SK, He X, Jacobs ML, Shah SS, Peterson ED, Gaies MG, et al. Excess costs associated with complications and prolonged length of stay after congenital heart surgery. Ann Thorac Surg. 2014 Nov;98(5):1660–6.
Pasquali, Sara K., et al. “Excess costs associated with complications and prolonged length of stay after congenital heart surgery.Ann Thorac Surg, vol. 98, no. 5, Nov. 2014, pp. 1660–66. Pubmed, doi:10.1016/j.athoracsur.2014.06.032.
Pasquali SK, He X, Jacobs ML, Shah SS, Peterson ED, Gaies MG, Hall M, Gaynor JW, Hill KD, Mayer JE, Li JS, Jacobs JP. Excess costs associated with complications and prolonged length of stay after congenital heart surgery. Ann Thorac Surg. 2014 Nov;98(5):1660–1666.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

November 2014

Volume

98

Issue

5

Start / End Page

1660 / 1666

Location

Netherlands

Related Subject Headings

  • United States
  • Respiratory System
  • Postoperative Complications
  • Male
  • Length of Stay
  • Infant
  • Humans
  • Hospital Costs
  • Heart Defects, Congenital
  • Female