Pasquali Sara K, He Xia, Jacobs Marshall L, Shah Samir S, Peterson Eric D, Gaies Michael G, Hall Matthew, Gaynor J William, Hill Kevin D, Mayer John E, Li Jennifer S, Jacobs Jeffrey P
Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan.
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2014 Nov;98(5):1660-6. doi: 10.1016/j.athoracsur.2014.06.032. Epub 2014 Sep 4.
While there is an increasing emphasis on both optimizing quality of care and reducing health care costs, there are limited data regarding how to best achieve these goals for common and resource-intense conditions such as congenital heart disease. We evaluated excess costs associated with complications and prolonged length of stay (LOS) after congenital heart surgery in a large multicenter cohort.
Clinical data from The Society of Thoracic Surgeons Database were linked to estimated costs from the Pediatric Health Information Systems Database (2006 to 2010). Excess cost per case associated with complications and prolonged LOS was modeled for 9 operations of varying complexity adjusting for patient baseline characteristics.
Of 12,718 included operations (27 centers), average excess cost per case in those with any complication (versus none) was $56,584 (+$132,483 for major complications). The 5 highest cost complications were tracheostomy, mechanical circulatory support, respiratory complications, renal failure, and unplanned reoperation or reintervention (ranging from $57,137 to $179,350). Patients with an additional day of LOS above the median had an average excess cost per case of $19,273 (+$40,688 for LOS 4 to 7 days above median). Potential cost savings in the study cohort achievable through reducing major complications (by 10%) and LOS (by 1 to 3 days) were greatest for the Norwood operation ($7,944,128 and $3,929,351, respectively) and several other commonly performed operations of more moderate complexity.
Complications and prolonged LOS after congenital heart surgery are associated with significant costs. Initiatives able to achieve even modest reductions in these morbidities may lead to both improved outcomes and cost savings across both moderate and high complexity operations.
尽管人们越来越强调优化医疗质量和降低医疗成本，但对于如何在先天性心脏病等常见且资源密集型疾病中最好地实现这些目标，相关数据有限。我们在一个大型多中心队列中评估了先天性心脏手术后与并发症及延长住院时间（LOS）相关的额外费用。
胸外科医师协会数据库中的临床数据与儿科健康信息系统数据库（2006年至2010年）的估计费用相关联。针对9种不同复杂程度的手术，根据患者基线特征进行调整，对与并发症和延长LOS相关的每例额外费用进行建模。
在纳入的12718例手术（27个中心）中，有任何并发症（与无并发症相比）的患者每例平均额外费用为56584美元（重大并发症为132483美元）。费用最高的5种并发症是气管切开术、机械循环支持、呼吸并发症、肾衰竭以及计划外再次手术或再次干预（从57137美元到179350美元不等）。住院时间超过中位数一天的患者每例平均额外费用为19273美元（住院时间超过中位数4至7天为40688美元）。通过减少重大并发症（10%）和住院时间（1至3天）在研究队列中可实现的潜在成本节约，对于诺伍德手术（分别为7944128美元和3929351美元）以及其他几种复杂度适中的常见手术而言最大。
先天性心脏手术后的并发症和延长住院时间与巨大成本相关。能够在这些发病率上实现哪怕适度降低的举措，可能会改善中度和高度复杂手术的结局并节省成本。
