The average hospital stay for pediatric patients requiring a ventricular assist device (VAD) spans nearly three months and costs $750,000, according to a registry analysis published June 1 in the Journal of the American Heart Association.
Surprisingly, the researchers found device type and postoperative complications weren’t associated with increased costs upon multivariable analysis. However, the number of complex chronic conditions (CCCs) was strongly linked to resource utilization, with median costs ranging from $632,322 for patients with no CCCs to more than $1.2 million for those with at least three CCCs.
Overall, the hospital costs associated with pediatric VADs were two to four times higher than what has been reported in adult VAD populations.
“Even in the context of surgery for complex congenital heart disease, the resource utilization in pediatric VAD patients is high,” wrote lead author Joseph W. Rossano, MD, with Children’s Hospital of Philadelphia and the University of Pennsylvania, and colleagues. “In the multicenter Single Ventricle Reconstruction Trial for hypoplastic left heart syndrome, the median postoperative hospital LOS (length of stay) was 24 days, a greater than three‐fold decrease from what was observed in pediatric VAD patients.”
One possible reason for these findings is pediatric patients are typically given VADs as a bridge-to-transplant therapy, and they often remain in the hospital until cardiac transplantation. Adults, on the other hand, are discharged and can be implanted with VADs as a destination therapy.
Among the 142 children in this study, only 4 percent were given VADs as a destination therapy. Discharge before transplantation was rare among patients with continuous-flow VADs but was associated with a 12 percent reduction in overall costs.
“This cost savings was likely not greater because the total days hospitalized were still high among patients discharged home (median 60 days) and not significantly less than that of patients who remained hospitalized (median 72 days),” the authors wrote. “Discharging patients safely, in a timely manner, and preventing rehospitalizations are key proposed strategies for reducing healthcare costs in many populations, including heart failure patients, and would seem to hold promise for decreasing resource utilization in pediatric VAD patients.”
Other factors that were independently predictive of increased costs included patient age, admission at a lower-volume VAD center, being intubated and being on extracorporeal membrane oxygenation (ECMO). The patients were a median of 9 years old at VAD implantation and had an average length of stay of 81 days, including 43 in the intensive care unit.
“As the field looks for strategies to improve the cost‐effectiveness of VADs, identifying best practices from high‐performing centers and targeting potentially modifiable risk factors, such as intubation and ECMO before VAD, would be reasonable starting points for quality improvement initiatives,” Rossano and coauthors wrote.
The authors acknowledged the small sample size of their study may limit the ability to detect all the factors associated with increased hospital costs. In addition, they said the close relationship between some of the factors makes it difficult to separate the relative impact of each variable.