Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Heart Lung Transplant. 2021 Jun;40(6):478-487. doi: 10.1016/j.healun.2021.02.011. Epub 2021 Feb 22.
Paracorporeal continuous-flow ventricular assist devices (PCF VAD) are increasingly used in pediatrics, yet PCF VAD resource utilization has not been reported to date.
Pediatric Interagency Registry for Mechanically Assisted Circulatory Support (PediMACS), a national registry of VADs in children, and Pediatric Health Information System (PHIS), an administrative database of children's hospitals, were merged to assess VAD implants from 19 centers between 2012 and 2016. Resource utilization, including hospital and intensive care unit length of stay (LOS), and costs are analyzed for PCF VAD, durable VAD (DVAD), and combined PCF-DVAD support.
Of 177 children (20% PCF VAD, 14% PCF-DVAD, 66% DVAD), those with PCF VAD or PCF-DVAD are younger (median age 4 [IQR 0-10] years and 3 [IQR 0-9] years, respectively) and more often have congenital heart disease (44%; 28%, respectively) compared to DVAD (11 [IQR 3-17] years; 14% CHD); p < 0.01 for both. Median post-VAD LOS is prolonged ranging from 43 (IQR 15-82) days in PCF VAD to 72 (IQR 55-107) days in PCF-DVAD, with significant hospitalization costs (PCF VAD $450,000 [IQR $210,000-$780,000]; PCF-DVAD $770,000 [IQR $510,000-$1,000,000]). After adjusting for patient-level factors, greater post-VAD hospital costs are associated with LOS, ECMO pre-VAD, greater chronic complex conditions, and major adverse events (p < 0.05 for all). VAD strategy and underlying cardiac disease are not associated with LOS or overall costs, although PCF VAD is associated with higher daily-level costs driven by increased pharmacy, laboratory, imaging, and clinical services costs.
Pediatric PCF VAD resource utilization is staggeringly high with costs primarily driven by pre-implantation patient illness, hospital LOS, and clinical care costs.
体外连续流心室辅助装置（PCF VAD）在儿科中的应用越来越广泛，但迄今为止尚未报告 PCF VAD 的资源利用情况。
儿科机械循环支持机构间注册（PediMACS）是一个儿童 VAD 国家注册处，儿科健康信息系统（PHIS）是儿童医院的行政数据库，我们将这两个数据库合并，评估了 2012 年至 2016 年间 19 个中心的 VAD 植入情况。分析了 PCF VAD、耐用性 VAD（DVAD）和 PCF-DVAD 联合支持的资源利用情况，包括医院和重症监护病房的住院时间（LOS）和费用。
在 177 名儿童中（20%为 PCF VAD，14%为 PCF-DVAD，66%为 DVAD），PCF VAD 或 PCF-DVAD 患儿年龄更小（中位数年龄 4[IQR 0-10]岁和 3[IQR 0-9]岁，分别），更常患有先天性心脏病（44%；28%，分别），而 DVAD 患儿为 11[IQR 3-17]岁；14%的先天性心脏病）；两者均 p<0.01。VAD 后 LOS 中位数延长，范围从 PCF VAD 的 43（IQR 15-82）天到 PCF-DVAD 的 72（IQR 55-107）天，且住院费用显著增加（PCF VAD 为 450,000 美元[IQR 210,000-780,000]；PCF-DVAD 为 770,000 美元[IQR 510,000-1000,000]）。在校正了患者水平因素后，VAD 后住院费用的增加与 LOS、VAD 前 ECMO、更多慢性复杂疾病和主要不良事件相关（所有 p<0.05）。VAD 策略和基础心脏病与 LOS 或总费用无关，但 PCF VAD 与更高的每日费用相关，这主要是由于增加了药房、实验室、影像学和临床服务费用。
儿科 PCF VAD 的资源利用非常高，其费用主要由植入前患者疾病、住院 LOS 和临床护理费用驱动。
