Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-23T02:32:42.259Z Has data issue: false hasContentIssue false
  • English
  • Français

A multi-institutional study of factors affecting resource utilisation following the Fontan operation

Published online by Cambridge University Press:  30 August 2016

Kevin A. Hinkle ,
Jacob Wilkes ,
Molly McFadden ,
Richard V. Williams ,
LuAnn L. Minich  and
Shaji C. Menon
Kevin A. Hinkle
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
Jacob Wilkes
Affiliation:
Pediatric Clinical Programs, Intermountain Healthcare, Salt Lake City, Utah, United States of America
Molly McFadden
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
Richard V. Williams
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
LuAnn L. Minich
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
Shaji C. Menon*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
*
Correspondence to: S. C. Menon, MD, 81 N. Mario Capecchi Drive, Salt Lake City, UT 84113, Tel: 801 213 3599, Fax: 801 213 7778; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The few studies evaluating data on resource utilisation following the Fontan operation specifically are outdated. We sought to evaluate resource utilisation and factors associated with increased resource use after the Fontan operation in a contemporary, large, multi-institutional cohort. This retrospective cohort study of children who had the Fontan between January, 2004 and June, 2013 used the Pediatric Health Information Systems Database. Generalised linear regression analyses evaluated factors associated with resource use. Of 2187 Fontan patients included in the study, 62% were males. The median age at Fontan was 3.2 years (inter-quartile range (IQR): 2.6–3.8). The median length of stay following the Fontan was 9 days (IQR: 7–14). The median costs and charges in 2012 dollars for the Fontan operation were $93,900 (IQR: $67,800–$136,100) and $156,000 (IQR: $112,080–$225,607), respectively. Postoperative Fontan mortality (30 days) was 1% (n=21). Factors associated with increased resource utilisation included baseline and demographic factors such as region, race, and renal anomaly, factors at the bidirectional Glenn such as seizures, valvuloplasty, and surgical volume, number of admissions between the bidirectional Glenn and the Fontan, and factors at the Fontan such as surgical volume and age at Fontan. The most strongly associated factors for both increased Fontan length of stay and increased Fontan charges were number of bidirectional Glenn to Fontan admissions (p<0.001) and Fontan surgical volume per year (p<0.001). As patient characteristics and healthcare-related delivery variables accounted for most of the factors predicting increased resource utilisation, changes should target healthcare delivery factors to reduce costs in this resource-intensive population.

Keywords

CHDFontanresource utilisation
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 4 , May 2017 , pp. 739 - 746
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Iyengar, AJ, Winlaw, DS, Galati, JC, et al. Trends in Fontan surgery and risk factors for early adverse outcomes after Fontan surgery: the Australia and New Zealand Fontan registry experience. J Thorac Cardiovasc Surg 2014; 148: 566–575.CrossRefGoogle ScholarPubMed
2. Kogon, BE, Plattner, C, Leong, T, Simsic, J, Kirshbom, PM, Kanter, KR. The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg 2008; 136: 1237–1242.CrossRefGoogle ScholarPubMed
3. Pasquali, SK, Jacobs, ML, He, X, et al. Variation in congenital heart surgery costs across hospitals. Pediatrics 2014; 133: e553–e560.Google Scholar
4. Dean, PN, Hillman, DG, McHugh, KE, Gutgesell, HP. Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome. Pediatrics 2011; 128: e1181–e1186.Google Scholar
5. Pasquali, SK, He, X, Jacobs, ML, et al. Excess costs associated with complications and prolonged length of stay after congenital heart surgery. Ann Thorac Surg 2014; 98: 1660–1666.Google Scholar
6. Benavidez, OJ, Connor, JA, Gauvreau, K, Jenkins, KJ. The contribution of complications to high resource utilization during congenital heart surgery admissions. Congenit Heart Dis 2007; 2: 319–326.CrossRefGoogle ScholarPubMed
7. Hosein, RB, Clarke, AJ, McGuirk, SP, et al. Factors influencing early and late outcome following the Fontan procedure in the current era. The ‘Two Commandments’? Eur J Cardiothorac Surg 2007; 31: 344–352; discussion 353.CrossRefGoogle ScholarPubMed
8. Rogers, LS, Glatz, AC, Ravishankar, C, et al. 18 years of the Fontan operation at a single institution: results from 771 consecutive patients. J Am Coll Cardiol 2012; 60: 1018–1025.Google Scholar
9. Tweddell, JS, Nersesian, M, Mussatto, KA, et al. Fontan palliation in the modern era: factors impacting mortality and morbidity. Ann Thorac Surg 2009; 88: 1291–1299.CrossRefGoogle ScholarPubMed
10. Hirsch, JC, Goldberg, C, Bove, EL, et al. Fontan operation in the current era: a 15-year single institution experience. Ann Surg 2008; 248: 402–410.Google Scholar
11. United States Census Bureau. Retrieved October, 2013 from http://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.Google Scholar
12. Keren, R, Luan, X, Localio, R, et al. Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med 2012; 166: 1155–1164.Google Scholar
13. Bureau of Labor Statistics. CPI detailed report, December 2013.Retrieved October, 2013 from https://www.bls.gov/cpi.Google Scholar
14. Wolf, MJ, Lee, EK, Nicolson, SC, et al. Rationale and methodology of a collaborative learning project in congenital cardiac care. Am Heart J 2016; 174: 129–137.CrossRefGoogle Scholar
15. Gajarski, RJ, Towbin, JA, Garson, A Jr. Fontan palliation versus heart transplantation: a comparison of charges. Am Heart J 1996; 131: 1169–1174.Google Scholar