Division of Pediatric Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
Intermountain Healthcare, Pediatric Clinical Program, Salt Lake City, Utah.
J Thorac Cardiovasc Surg. 2018 Jun;155(6):2606-2614.e5. doi: 10.1016/j.jtcvs.2018.01.100. Epub 2018 Feb 21.
Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality.
We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004 and 2013 by using the Pediatric Health Information Systems database (44 children's hospitals). Multivariate generalized estimating equations adjusted for center- and patient-specific risk factors and stratified by age at admission were performed to examine the association of admission intensive care unit (ICU) with total hospital costs, mortality, and length of stay.
Of 19,984 neonates (60% male) identified, 39% were initially admitted to a cardiac ICU (CICU), 48% to a neonatal ICU (NICU), and 13% to a pediatric ICU. In adjusted models, admission to a CICU versus NICU was associated with a $20,440 reduction in total hospital cost for infants aged 2 to 7 days at admission (P = .007) and a $23,700 reduction in total cost for infants aged 8 to 14 days at admission (P = .01). Initial admission to a CICU or pediatric ICU versus NICU at <15 days of age was associated with shorter hospital and ICU length of stay and fewer days of mechanical ventilation. There was no difference in adjusted mortality by admission location.
Admission to an ICU specializing in cardiac care is associated with significantly decreased hospital costs and more efficient resource use for neonates requiring cardiac surgery.
接受先天性心脏手术的新生儿需要高度专业化、资源密集型的护理。护理地点和专业化程度在机构之间和内部可能有所不同。我们使用多机构队列，旨在确定入院地点是否与医疗保健费用增加、资源使用和死亡率增加有关。
我们回顾性分析了 2004 年至 2013 年间接受先天性心脏手术的新生儿（<30 天）的入院情况，使用了儿科健康信息系统数据库（44 家儿童医院）。采用多变量广义估计方程，根据中心和患者特定的危险因素进行调整，并按入院时的年龄分层，以检查入院重症监护病房（ICU）与总住院费用、死亡率和住院时间的关系。
在确定的 19984 名新生儿中（60%为男性），39%最初被收治在心脏 ICU（CICU），48%被收治在新生儿 ICU（NICU），13%被收治在儿科 ICU。在调整后的模型中，与 NICU 相比，CICU 入院与 2 至 7 天龄婴儿的总住院费用降低 20440 美元（P = 0.007），与 8 至 14 天龄婴儿的总费用降低 23700 美元（P = 0.01）。在<15 天龄时，最初被收治在 CICU 或儿科 ICU 而不是 NICU 与较短的住院和 ICU 住院时间以及较少的机械通气天数相关。入院地点与调整后的死亡率无差异。
对于需要心脏手术的新生儿，入住专门治疗心脏疾病的 ICU 与显著降低的医院费用和更有效的资源利用相关。
