Lawley Claire M, Lain Samantha J, Figtree Gemma A, Sholler Gary F, Winlaw David S, Roberts Christine L
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia; North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Int J Cardiol. 2017 Aug 15;241:156-162. doi: 10.1016/j.ijcard.2017.03.113. Epub 2017 Mar 27.
Cardiac procedures are part of management for many children with congenital heart disease (CHD). Using population health data, this study explores health outcomes of children undergoing a cardiac procedure in the first year of life to better understand the impact of CHD on children, families and health services.
A population-based record-linkage cohort study was undertaken. Rate of cardiac procedures in the first year of life over the study period 2001-2012 in New South Wales, Australia, was steady at 2.5 children per 1000 live births, accounting for 2722 children. Excluding those with isolated closure of patent ductus arteriosus (n=416), 50% required readmission in the first year of life. Over 1/5th had an additional non-cardiac congenital anomaly. Average total cost per infant for initial procedure admission was $67,054 AUD ($63,124-$70,984) with a median length of stay (LOS) 13days (IQR 8-23). Average cost per readmission in the first year of life was $11,342 (95% CI 10,361-$12,323) with median LOS 2days (IQR 1-5). Mortality rate in the 30days following initial procedure was 3.1% (72/2306). Mortality rate by age 1year was 7.1%, and 13.8% for those who had neonatal surgery.
Risk of mortality in operatively-managed CHD extends beyond the immediate perioperative period. Children undergoing a cardiac procedure in their first year are often readmitted to hospital for both further planned procedures and unplanned reasons such as infection. These readmissions capture the significant impact of illness and pose substantial financial cost to the health system.
心脏手术是许多先天性心脏病（CHD）患儿治疗的一部分。本研究利用人群健康数据，探讨在生命第一年接受心脏手术的儿童的健康结局，以更好地了解CHD对儿童、家庭和医疗服务的影响。
开展了一项基于人群的记录链接队列研究。在澳大利亚新南威尔士州2001 - 2012年研究期间，生命第一年的心脏手术率稳定在每1000例活产中有2.5名儿童，共有2722名儿童。排除单纯动脉导管未闭封堵术患儿（n = 416）后，50%的患儿在生命第一年需要再次入院。超过五分之一的患儿有额外的非心脏先天性异常。初次手术入院时，每名婴儿的平均总费用为67,054澳元（63,124 - 70,984澳元），中位住院时间为13天（四分位间距8 - 23天）。生命第一年再次入院的平均费用为11,342澳元（95%置信区间10,361 - 12,323澳元），中位住院时间为2天（四分位间距1 - 5天）。初次手术后30天内的死亡率为3.1%（72/2306）。1岁时的死亡率为7.1%，接受新生儿手术的患儿死亡率为13.8%。
手术治疗的CHD的死亡风险不仅限于围手术期。在生命第一年接受心脏手术的儿童常因进一步的计划手术和感染等非计划原因再次入院。这些再次入院体现了疾病的重大影响，并给卫生系统带来了巨大的经济成本。
