Essaid Luma, Strassle Paula D, Jernigan Eric G, Nelson Jennifer S
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Pediatr Cardiol. 2018 Aug;39(6):1229-1235. doi: 10.1007/s00246-018-1887-7. Epub 2018 May 12.
Hypoplastic left heart syndrome (HLHS) is a highly resource-intensive diagnosis. Geographic variation in cost and length of stay (LOS) in HLHS is not well described. Neonates diagnosed with HLHS between 2000 and 2012 were identified using the Kids' Inpatient Database. Hospitalizations were stratified into two groups: (1) birth and (2) secondary. United States regional differences in hospital charges and LOS were compared using adjusted linear regression. Of 2431 birth hospitalizations, 449 neonates (18.5%) died while inpatient and mortality rates differed by region (p = 0.02). After birth, 40.5% (n = 985) of neonates were transferred; transfers were most common in the Midwest (p < 0.0001). Adjusted average LOS was shortest in the West and longest in the South (26.1 days; 95% CI 24.0, 35.1 vs. 34.9 days; 95% CI 31.8, 38.1). Average adjusted charges were lowest in the Northeast ($324,600; 95% CI $271,400, $377,900) and highest in the West ($400,500; 95% CI $346,700, $454,300, p = 0.05). Among 1895 secondary hospitalizations, 24.9% of neonates died as inpatients, and the average adjusted LOS was shortest in the West (26.8 days; 95% CI 23.9, 29.7) and longest in the South (38.5 days; 95% CI 34.4, 42.4). Average adjusted charges were lowest in the Northeast ($326,900; 95% CI $270,700, $383,100) and highest in the South ($505,900; 95% CI $450,200, $561,500, p < 0.0001). Significant geographic variations in mortality, LOS, and hospital charges exist in care of US HLHS neonates. Reducing variation in care should remain a priority in national quality efforts in congenital heart disease.
左心发育不全综合征（HLHS）是一种资源消耗极高的诊断疾病。HLHS治疗费用和住院时间（LOS）的地区差异尚无详尽描述。利用儿童住院数据库确定了2000年至2012年间诊断为HLHS的新生儿。住院情况分为两组：（1）出生时和（2）继发时。采用调整后的线性回归比较美国各地区在医院收费和住院时间方面的差异。在2431例出生时住院病例中，449例新生儿（18.5%）在住院期间死亡，且死亡率因地区而异（p = 0.02）。出生后，40.5%（n = 985）的新生儿被转诊；转诊在中西部最为常见（p < 0.0001）。调整后的平均住院时间在西部最短，在南部最长（26.1天；95%可信区间24.0，35.1对比34.9天；95%可信区间31.8，38.1）。调整后的平均费用在东北部最低（324,600美元；95%可信区间271,400美元，377,900美元），在西部最高（400,500美元；95%可信区间346,700美元，454,300美元，p = 0.05）。在1895例继发时住院病例中，24.9%的新生儿在住院期间死亡，调整后的平均住院时间在西部最短（26.8天；95%可信区间23.9，29.7），在南部最长（38.5天；95%可信区间34.4，42.4）。调整后的平均费用在东北部最低（326,900美元；95%可信区间270,700美元，383,100美元），在南部最高（505,900美元；95%可信区间450,200美元，561,500美元，p < 0.0001）。美国HLHS新生儿护理在死亡率、住院时间和医院收费方面存在显著的地区差异。减少护理差异应始终是国家先天性心脏病质量改进工作的重点。
