Thomas Ian D, Seckeler Michael D
Department of Pediatrics, University of Arizona, Tucson, Arizona.
Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona.
Am J Cardiol. 2016 May 15;117(10):1661-1666. doi: 10.1016/j.amjcard.2016.02.043. Epub 2016 Mar 2.
Patients with single ventricle (SV) congenital heart disease (CHD) incur high hospital costs during staged surgical palliation. Health care resource utilization for noncardiac admissions in patients with SV has not been reported. This study sought to compare costs and outcomes for common noncardiac hospital admissions between patients with SV and patients without CHD. Hospital discharge data from the University Health System Consortium from January 2011 to December 2013 was queried for patients aged ≤18 years with International Classification of Diseases, Ninth Revision (ICD-9) codes for SV lesions: hypoplastic left heart syndrome (746.7), tricuspid atresia (746.1), or common ventricle (745.3). Primary diagnosis, direct cost, length of stay (LOS), intensive care unit admission rate and mortality data were obtained. The 10 most common noncardiac admission diagnoses were compared between patients with SV and patients without CHD using t test and Fisher's exact test. Total direct cost, LOS, and intensive care unit admission rate were higher for patients with SV for all diagnoses with the exception of LOS for dehydration, which was not different between groups. Hospital mortality was significantly higher for patients with SV admitted for acute kidney injury, esophageal reflux, failure to thrive, respiratory syncytial virus bronchiolitis and pneumonia. In conclusion, our study demonstrates that patients with SV CHD admitted with noncardiac diagnoses have higher health care resource utilization compared to those without CHD. As long-term survival increases, it can be expected that this patient group will use a disproportionate amount of medical dollars. Further characterization of costs will be important so steps can be taken to reduce or prevent hospitalization in these patients.
单心室（SV）先天性心脏病（CHD）患者在分期手术姑息治疗期间会产生高昂的住院费用。目前尚未有关于SV患者非心脏疾病住院的医疗资源利用情况的报道。本研究旨在比较SV患者和非CHD患者常见非心脏疾病住院的费用和结局。查询了大学卫生系统联盟2011年1月至2013年12月期间年龄≤18岁、具有国际疾病分类第九版（ICD - 9）编码的SV病变患者的出院数据：左心发育不全综合征（746.7）、三尖瓣闭锁（746.1）或共同心室（745.3）。获取了主要诊断、直接费用、住院时间（LOS）、重症监护病房入住率和死亡率数据。使用t检验和Fisher精确检验比较了SV患者和非CHD患者10种最常见的非心脏疾病住院诊断。除脱水的LOS在两组之间无差异外，SV患者所有诊断的总直接费用、LOS和重症监护病房入住率均更高。因急性肾损伤、食管反流、发育不良、呼吸道合胞病毒细支气管炎和肺炎入院的SV患者的医院死亡率显著更高。总之，我们的研究表明，与非CHD患者相比，因非心脏疾病诊断入院的SV CHD患者医疗资源利用更高。随着长期生存率的提高，可以预期该患者群体将消耗不成比例的医疗费用。进一步明确费用情况将很重要，以便能够采取措施减少或预防这些患者的住院治疗。
