Adults undergoing surgeries for congenital heart disease (CHD) in pediatric hospitals do so at a lofty price tag, according to a report published Oct. 18 in Circulation: Quality and Outcomes. In fact, the researchers found that compared with lower-cost and lower-risk surgeries, more costly surgeries were linked with higher rates of inpatient death.
“Adults with congenital heart disease now outnumber the pediatric congenital heart population," Yuli Y. Kim, MD, pediatric cardiologist at the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia, and colleagues wrote. “Hospitalizations for these adult patients have doubled over the past 20 years, with congenital heart surgery accounting for nearly 20 percent of these admissions.”
Recently pediatric hospitals have been performing congenital heart surgeries in adult patients, a development that prompted Kim et al to understand resource use by adult patients undergoing congenital heart surgeries at pediatric hospitals.
To do so, Kim and colleagues gathered inpatient adult congenital heart surgery admissions data from 42 pediatric hospitals from 2000 to 2008. The researchers defined high resource use (HRU) admissions as those exceeding the 90th percentile for total hospital charges. The authors then performed multivariable analyses using generalized estimated equations to identify risk factors for HRU.
The study included 97,563 adult and pediatric congenital cardiac surgical admissions—3.1 percent of these were adult CHD patients.
The researchers found the following admissions to be associated with higher resource use: those with a higher surgical complexity, those that used government insurance, DiGeorge syndrome presence, those with depression as well as weekend admissions. Additionally, these HRU admissions also were linked to a higher rate of death.
Median length of stay was reported to be five days, and more than 90 percent of admissions were discharged to the home. Sixty-seven adult patients died in pediatric hospitals.
Adults made up 3.1 percent of all congenital heart surgery admissions; however, they used only 2.2 percent of the total hospital charges. Kim et al reported median hospital charges for adult congenital heart surgery to be $88,759. In comparison, the price of a congenital heart surgery admission for pediatric patients was $92,529. The researchers reported costs for surgeries within the 90th percentile threshold to be $213,803.
Of the patient cohort, 307 of these admissions represented high-resource admissions. Median length of stay for these HRU admissions was 19 days versus five days for a non-HRU admission.
Inpatient mortality was also higher for HRU admissions compared with non-HRU admissions, 16 percent vs. 0.7 percent, respectively. Median total hospital charges for an HRU admission was $299,901 compared with $82,738 for non-HRU admissions.
"The most interesting and actionable of our findings was that depression is a risk factor for high resource use among this surgical population. While we cannot change a patient's surgery complexity or presence of DiGeorge syndrome, we might be able to implement a treatment strategy for a potentially modifiable risk factor such as depression,” Oscar J. Benavidez, MD, co-author of the study, and chief of the division of pediatric-congenital cardiology at Massachusetts General Hospital in Boston, said in a statement.
“One could imagine implementing a screening and treatment program for depression and assessing its impact in inpatient resource use,” he added.
As the adult congenital heart disease population continues to grow, so will the resources required to treat this patient population.
"While the number of adult congenital heart patients who undergo surgery at pediatric hospitals continues to increase, we also found that the lion's share of surgical costs is with pediatric patients," Benavidez concluded. "The pediatric patients are resource intensive in their own right, given that their extreme complexity requires highly specialized processes to care adequately for these infants and children."