Department of Pediatrics, University of Virginia Health System, Charlottesville, VA 22908-0386, USA.
Pediatrics. 2011 Nov;128(5):e1181-6. doi: 10.1542/peds.2010-3742. Epub 2011 Oct 10.
Hypoplastic left heart syndrome (HLHS) is one of the most serious congenital cardiac anomalies. Typically, it is managed with a series of 3 palliative operations or cardiac transplantation. Our goal was to quantify the inpatient resource burden of HLHS across multiple academic medical centers.
The University HealthSystem Consortium is an alliance of 101 academic medical centers and 178 affiliated hospitals that share diagnostic, procedural, and financial data on all discharges. We examined inpatient resource use by patients with HLHS who underwent a staged palliative procedure or cardiac transplantation between 1998 and 2007.
Among 1941 neonates, stage 1 palliation (Norwood or Sano procedure) had a median length of stay (LOS) of 25 days and charges of $214,680. Stage 2 and stage 3 palliation (Glenn and Fontan procedures, respectively) had median LOS and charges of 8 days and $82,174 and 11 days and $79,549, respectively. Primary neonatal transplantation had an LOS of 87 days and charges of $582,920, and rescue transplantation required 36 days and $411,121. The median inpatient wait time for primary and rescue transplants was 42 and 6 days, respectively. Between 1998 and 2007, the LOS for stage 1 palliation increased from 16 to 28 days and inflation-adjusted charges increased from $122,309 to $280,909, largely because of increasing survival rates (57% in 1998 and 83% in 2007).
Patients with HLHS demand considerable inpatient resources, whether treated with the Norwood-Glenn-Fontan procedure pathway or cardiac transplantation. Improved survival rates have led to increased hospital stays and costs.
左心发育不全综合征（HLHS）是最严重的先天性心脏畸形之一。通常，它通过一系列 3 次姑息性手术或心脏移植来治疗。我们的目标是量化多个学术医疗中心 HLHS 的住院资源负担。
大学健康联盟是由 101 家学术医疗中心和 178 家附属医院组成的联盟，这些机构共享所有出院患者的诊断、程序和财务数据。我们研究了 1998 年至 2007 年间接受分期姑息性手术或心脏移植的 HLHS 患者的住院资源使用情况。
在 1941 名新生儿中，1 期姑息治疗（Norwood 或 Sano 手术）的中位住院时间（LOS）为 25 天，费用为 214680 美元。2 期和 3 期姑息治疗（分别为 Glenn 和 Fontan 手术）的 LOS 和费用中位数分别为 8 天和 82174 美元、11 天和 79549 美元。原发性新生儿移植的 LOS 为 87 天，费用为 582920 美元，抢救性移植需要 36 天和 411121 美元。原发性和抢救性移植的中位住院等待时间分别为 42 天和 6 天。1998 年至 2007 年间，1 期姑息治疗的 LOS 从 16 天增加到 28 天，经通胀调整后的费用从 122309 美元增加到 280909 美元，这主要是因为生存率的提高（1998 年为 57%，2007 年为 83%）。
无论采用 Norwood-Glenn-Fontan 治疗途径还是心脏移植，HLHS 患者都需要大量的住院资源。生存率的提高导致住院时间和费用增加。
