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Evolving Cost-Quality Relationship in Pediatric Heart Surgery.

Publication ,  Journal Article
Pasquali, SK; Thibault, D; Hall, M; Chiswell, K; Romano, JC; Gaynor, JW; Shahian, DM; Jacobs, ML; Gaies, MG; O'Brien, SM; Norton, EC; Hill, KD ...
Published in: Ann Thorac Surg
March 2022

BACKGROUND: For the more than 40,000 children in the United States undergoing congenital heart surgery annually, the relationship between hospital quality and costs remains unclear. Prior studies report conflicting results and clinical outcomes have continued to improve over time. We examined a large contemporary cohort, aiming to better inform ongoing initiatives seeking to optimize health care value in this population. METHODS: Clinical information (The Society of Thoracic Surgeons Congenital Database) was merged with standardized cost data (Pediatric Health Information Systems) for children undergoing heart surgery from 2010 to 2015. In-hospital cost variability was analyzed using Bayesian hierarchical models adjusted for case-mix. Quality metrics examined included in-hospital mortality, postoperative complications, postoperative length of stay (PLOS), and a composite. RESULTS: Overall, 32 hospitals (n = 45,315 patients) were included. Median adjusted cost per case varied across hospitals from $67,700 to $51,200 in the high vs low cost tertile (ratio 1.32; 95% credible interval, 1.29 to 1.35), and all quality metrics also varied across hospitals. Across cost tertiles, there were no significant differences in the quality metrics examined, with the exception of PLOS. The PLOS findings were driven by high-risk The Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery categories 4 and 5 cases (adjusted median length of stay 16.8 vs 14.9 days in high vs low cost tertile [ratio 1.13, 1.05 to 1.24]), and intensive care unit PLOS. CONCLUSIONS: Contemporary congenital heart surgery costs vary across hospitals but were not associated with most quality metrics examined, highlighting that performance in one area does not necessarily convey to others. Cost variability was associated with PLOS, particularly related to intensive care unit PLOS and high-risk cases. Care processes influencing PLOS may provide targets for value-based initiatives in this population.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2022

Volume

113

Issue

3

Start / End Page

866 / 873

Location

Netherlands

Related Subject Headings

  • United States
  • Thoracic Surgery
  • Respiratory System
  • Length of Stay
  • Humans
  • Hospital Costs
  • Heart Defects, Congenital
  • Child
  • Cardiac Surgical Procedures
  • Bayes Theorem
 

Citation

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ICMJE
MLA
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Pasquali, S. K., Thibault, D., Hall, M., Chiswell, K., Romano, J. C., Gaynor, J. W., … Jacobs, J. P. (2022). Evolving Cost-Quality Relationship in Pediatric Heart Surgery. Ann Thorac Surg, 113(3), 866–873. https://doi.org/10.1016/j.athoracsur.2021.05.050
Pasquali, Sara K., Dylan Thibault, Matt Hall, Karen Chiswell, Jennifer C. Romano, J William Gaynor, David M. Shahian, et al. “Evolving Cost-Quality Relationship in Pediatric Heart Surgery.Ann Thorac Surg 113, no. 3 (March 2022): 866–73. https://doi.org/10.1016/j.athoracsur.2021.05.050.
Pasquali SK, Thibault D, Hall M, Chiswell K, Romano JC, Gaynor JW, et al. Evolving Cost-Quality Relationship in Pediatric Heart Surgery. Ann Thorac Surg. 2022 Mar;113(3):866–73.
Pasquali, Sara K., et al. “Evolving Cost-Quality Relationship in Pediatric Heart Surgery.Ann Thorac Surg, vol. 113, no. 3, Mar. 2022, pp. 866–73. Pubmed, doi:10.1016/j.athoracsur.2021.05.050.
Pasquali SK, Thibault D, Hall M, Chiswell K, Romano JC, Gaynor JW, Shahian DM, Jacobs ML, Gaies MG, O’Brien SM, Norton EC, Hill KD, Cowper PA, Shah SS, Mayer JE, Jacobs JP. Evolving Cost-Quality Relationship in Pediatric Heart Surgery. Ann Thorac Surg. 2022 Mar;113(3):866–873.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

March 2022

Volume

113

Issue

3

Start / End Page

866 / 873

Location

Netherlands

Related Subject Headings

  • United States
  • Thoracic Surgery
  • Respiratory System
  • Length of Stay
  • Humans
  • Hospital Costs
  • Heart Defects, Congenital
  • Child
  • Cardiac Surgical Procedures
  • Bayes Theorem