Collins R Thomas, Fram Ricki Y, Tang Xinyu, Robbins James M, Sutton Martin St John
The University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, AR, USA; The University of Arkansas for Medical Sciences, Department of Internal Medicine, Little Rock, AR, USA.
Int J Cardiol. 2013 Oct 12;168(5):4596-601. doi: 10.1016/j.ijcard.2013.07.164. Epub 2013 Jul 25.
Most patients with single ventricle congenital heart disease (SV) are now expected to survive to adulthood. Medical comorbidities are common in SV.
We used data from 43 pediatric hospitals in the 2004 to 2011 Pediatric Health Information System database to identify patients ≥18 years of age admitted with International Classification of Diseases-9th Revision codes for a diagnosis of either hypoplastic left heart syndrome (HLHS), tricuspid atresia (TA) or common ventricle (CV). Primary (PD) and secondary diagnoses (SD), length of stay (LOS) and hospital charges were determined. Multilevel models were used to evaluate differences in demographics, diagnoses, and admission outcomes among the three subgroups (HLHS, TA, and CV). Interactions of charges with PD and admission year were examined using ANOVA.
There were 801 SV patients with 1330 admissions during the study period. Mean age was 24.8±6.2 years (55% male) and mean LOS was 6.8±11.3 days. Total hospital charges were $135 million with mean charge per admission of $101,131±205,808. The mean charge per day was $15,407±16,437. Hospital charges correlated with PD group (p<0.001). Admission rate remained stable (~180/year) from 2006 to 2011. LOS decreased (p=0.0308) and hospital charges per day increased across the study period (p<0.001). PD was non-cardiac in 28% of admissions. Liver-related conditions were more common in patients with HLHS (p<0.001).
Hospitalization costs in adults with SV are significant and are impacted by comorbid medical conditions. Hospitalization rates for adults with SV are not increasing. Gastroenterologic comorbidities including protein-losing enteropathy (PLE) are common in HLHS.
大多数单心室先天性心脏病（SV）患者如今有望存活至成年。SV患者常伴有其他疾病。
我们使用了2004年至2011年儿科健康信息系统数据库中43家儿科医院的数据，以识别年龄≥18岁、因国际疾病分类第九版编码诊断为左心发育不全综合征（HLHS）、三尖瓣闭锁（TA）或共同心室（CV）而入院的患者。确定了主要诊断（PD）和次要诊断（SD）、住院时间（LOS）和医院费用。使用多水平模型评估三个亚组（HLHS、TA和CV）在人口统计学、诊断和入院结局方面的差异。使用方差分析检查费用与PD和入院年份的交互作用。
在研究期间，有801例SV患者入院1330次。平均年龄为24.8±6.2岁（55%为男性），平均住院时间为6.8±11.3天。医院总费用为1.35亿美元，每次入院平均费用为101,131±205,808美元。每天平均费用为15,407±16,437美元。医院费用与PD组相关（p<0.001）。2006年至2011年入院率保持稳定（约每年180例）。在整个研究期间，住院时间缩短（p=0.0308），每天的医院费用增加（p<0.001）。28%的入院患者PD为非心脏疾病。与肝脏相关的疾病在HLHS患者中更为常见（p<0.001）。
SV成年患者的住院费用高昂，且受合并症影响。SV成年患者的住院率没有上升。包括蛋白丢失性肠病（PLE）在内的胃肠合并症在HLHS中很常见。
