Tuomela Krista E, Gordon John B, Cassidy Laura D, Johaningsmeir Sarah, Ghanayem Nancy S
Medical College of Wisconsin, Milwaukee, WI, 53201, USA.
Divisions of Special Needs, Department of Pediatrics, Pediatric Division of Special Needs, Milwaukee, WI, USA.
Pediatr Cardiol. 2017 Jun;38(5):1065-1070. doi: 10.1007/s00246-017-1620-y. Epub 2017 Apr 29.
Congenital heart disease (CHD) is often associated with chronic extracardiac co-morbid conditions (ECC). The presence of ECC has been associated with greater resource utilization during the operative period; however, the impact beyond hospital discharge has not been described. This study sought to understand the scope of chronic ECC in infants with CHD as well as to describe the impact of ECC on resource utilization after discharge from the index cardiac procedure. IRB approved this retrospective study of infants <1 year who had cardiac surgery from 2006 and 2011. Demographics, diagnoses, procedures, STAT score, and ECC were extracted from the medical record. Administrative data provided frequency of clinic and emergency room visits, admissions, cumulative hospital days, and hospital charges for 2 years after discharge from the index procedure. Data were compared using Mann-Whitney Rank Sum Test with p < 0.05 considered significant. ECC occurred in 55% (481/876) of infants. Median STAT score was higher in the group with ECC (3 vs. 2, p < 0.001). Resource utilization after discharge from the index procedure as defined by median hospital charges (78 vs. 10 K, p < 0.001 and unplanned hospital days 4 vs. 0, p < 0.001) was higher in those with ECC, and increased with the greater number of ECC, even after accounting for surgical complexity. STAT score and the presence of multiple ECC were associated with higher resource utilization following the index cardiac surgical procedure. These data may be helpful in deciding which children might benefit from a cardiac complex care program that partners families and providers to improve health and decrease healthcare costs.
先天性心脏病（CHD）常与慢性心外合并症（ECC）相关。ECC的存在与手术期间更高的资源利用率相关；然而，出院后的影响尚未得到描述。本研究旨在了解CHD婴儿中慢性ECC的范围，并描述ECC对首次心脏手术后出院后资源利用的影响。机构审查委员会（IRB）批准了这项对2006年至2011年接受心脏手术的1岁以下婴儿的回顾性研究。从病历中提取人口统计学、诊断、手术、STAT评分和ECC信息。行政数据提供了首次手术后出院后2年的门诊和急诊就诊频率、住院次数、累计住院天数和住院费用。使用Mann-Whitney秩和检验对数据进行比较，p<0.05被认为具有统计学意义。55%（481/876）的婴儿发生了ECC。ECC组的STAT评分中位数更高（3比2，p<0.001）。首次手术后出院后的资源利用情况，以住院费用中位数定义（78对10K，p<0.001）和非计划住院天数（4对0，p<0.001），ECC患儿更高，且即使在考虑手术复杂性后，随着ECC数量的增加而增加。STAT评分和多个ECC的存在与首次心脏手术后更高的资源利用相关。这些数据可能有助于确定哪些儿童可能从心脏综合护理计划中受益，该计划将家庭和医疗服务提供者联合起来，以改善健康状况并降低医疗成本。
