Outcomes and Costs of Cardiac Surgery in Adults with Congenital Heart Disease

Viviane G Nasr; David Faraoni; Anne Marie Valente; James A DiNardo

doi:10.1007/s00246-017-1669-7

Outcomes and Costs of Cardiac Surgery in Adults with Congenital Heart Disease

Pediatr Cardiol. 2017 Oct;38(7):1359-1364. doi: 10.1007/s00246-017-1669-7. Epub 2017 Jul 1.

Authors

Viviane G Nasr¹, David Faraoni², Anne Marie Valente³, James A DiNardo⁴

Affiliations

¹ Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. viviane.nasr@childrens.harvard.edu.
² Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada.
³ Department of Cardiology, Boston Children's Hospital and Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.

PMID: 28669107
DOI: 10.1007/s00246-017-1669-7

Abstract

Advances in pediatric cardiac surgical and medical care have led to increased survival of patients with congenital heart disease (CHD). Consequently, many CHD patients survive long enough to require cardiac surgery as adults. Using the 2013 Nationwide Inpatient Sample (NIS) database, we compared costs and outcomes for adult patients undergoing surgery for treatment of CHD to a reference population of adults undergoing CABG. Patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) procedure codes. We recorded the demographic characteristics, gender, ethnicity, hospital bed size, hospital length of stay, in-hospital mortality, and comorbidities. Patients with ACHD have higher incidences of in-hospital mortality (2.6 vs. 1.8%), and complication rates including neurologic complications (2.6 vs. 0.9%), thromboembolic complications (3.9 vs. 1.4%), arrhythmias (51.6 vs. 29.8%), hepatic failure (4.44 vs. 2.03%), and sepsis (7.24 vs. 4.61%) (all p < 0.001). In addition, cost is higher in patients with CHD (Coefficient = 0.116, 95% CI, 0.105-0.128; p < 0.001), Elixhauser score ≥ 7 (Coefficient = 0.114, 95% CI, 0.108-0.121; p < 0.001), neurologic complications (Coefficient = 0.169, 95% CI, 0.143-0.196; p < 0.001), thrombotic complications (Coefficient = 0.243, 95% CI, 0.222-0.265; p < 0.001), sepsis (Coefficient = 0.198, 95% CI, 0.185-0.211; p < 0.001), acute kidney injury (Coefficient = 0.056, 95% CI, 0.041-0.063; p < 0.001), elective cases (Coefficient = 0.047, 95% CI, 0.041-0.053; p < 0.001), and length of stay > 6 days (Coefficient = 0.703, 95% CI, 0.697-0.710; p < 0.001). This study shows that ACHD patients undergoing cardiac surgery experience higher hospital costs and poorer outcomes than a reference population of adult CABG patients. Recognition and treatment of comorbidities in ACHD patients undergoing cardiac surgery may provide an opportunity to improve perioperative outcomes in this growing patient population.

Keywords: Adult congenital heart disease; CABG; Cost; Outcomes.

MeSH terms

Adult
Aged
Cardiac Surgical Procedures / adverse effects
Cardiac Surgical Procedures / economics
Cardiac Surgical Procedures / statistics & numerical data*
Databases, Factual
Female
Heart Defects, Congenital / economics
Heart Defects, Congenital / mortality
Heart Defects, Congenital / surgery*
Hospital Costs / statistics & numerical data*
Hospital Mortality
Humans
Incidence
Length of Stay / statistics & numerical data
Male
Middle Aged
Postoperative Complications / epidemiology
Retrospective Studies
Treatment Outcome