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Outcomes and hospital costs associated with the Norwood operation: beyond morbidity and mortality

Published online by Cambridge University Press:  03 November 2014

Brian E. Kogon ,
Kirk Kanter ,
Bahaaldin Alsoufi ,
Kevin Maher  and
Matthew E. Oster
Brian E. Kogon*
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Kirk Kanter
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Bahaaldin Alsoufi
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Kevin Maher
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Matthew E. Oster
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
*
Correspondence to: Dr B. E. Kogon, MD, Emory University, Children’s Healthcare of Atlanta, Egleston, Atlanta, 30322 Georgia, United States of America. Tel: 678 372 7324; Fax: 404 785 6266; E-mail: [email protected]
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Abstract

Background

Although much is known about morbidity and mortality, there are limited data focussing on the financial aspect of the Norwood operation. Our objective is to characterise the hospitalisation and detail the hospital costs.

Methods

We retrospectively studied 86 newborns with hypoplastic left heart syndrome who underwent Norwood palliation between 2008 and 2012. Clinical and financial data were collected. Financial data have been reported for 2011–2012.

Results

At surgery, median age and weight of the patients were 4 days (range 1–13) and 3 kg (range 2–4.8), respectively. The median time from admission to surgery was 4 days (range 1–10), with the postoperative ICU stay and total length of stay at the hospital being 10 days (range 4–135) and 16 days (range 5–136), respectively. Discharge mortality was 14/86 (16%) patients.

For patients operated on between 2011 and 2012 (n=40), median hospital costs, charges, and collections per patient were $117,021, $433,054, and $198,453, respectively, and mean hospital costs, charges, and collections per patient were $322,765, $1,109,500, and $511,271, respectively.

A breakdown of total hospital costs (direct and indirect) by department showed that the top four areas of resource utilisation (excluding physician fees) were as follows: the cardiac ICU (35%), laboratory (12%), pharmacy (12%), and operating room (7%). Interestingly, point-of-care laboratory evaluations accounted for almost half of the laboratory total (5%). Extracorporeal membrane oxygenation, although only utilised in eight patients between 2011 and 2012, accounted for 7% of utilisation.General radiology only accounted for 2%, despite numerous radiographs.

Conclusions

Limited data are available that detail the hospitalisation and costs associated with the Norwood operation. We hope that this analysis will identify areas for quality and value improvement from both system and patient perspectives.

Keywords

Norwoodoutcomeshospital costs
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 853 - 859
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Copyright
© Cambridge University Press 2014 

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References

1. Reller, MD, Strickland, MJ, Riehle-Colarusso, T, Mahle, WT, Correa, A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr 2008; 153: 807–813.CrossRefGoogle ScholarPubMed
2. Jacobs, JP, O'Brien, SM, Pasquali, SK, et al. Richard E. Clark Paper: variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Richard Clark Award recipient for best use of the STS Congenital Heart Surgery Database. Ann Thorac Surg 2011; 92: 2184–2192; PMID: 22115229.CrossRefGoogle Scholar
3. Pasquali, SK, Gaies, MG, Jacobs, JP, Gaynor, JW, Jacobs, ML. Centre variation in cost and outcomes for congenital heart surgery. Cardiol Young 2012; 22: 796–799.Google Scholar
4. Pasquali, SK, Jacobs, ML, He, X, et al. Variation in congenital heart surgery costs across hospitals. Pediatrics 2014; 133: e553–e560.CrossRefGoogle ScholarPubMed
5. Mishra, V, Lindberg, H, Seem, E, et al. A comparison of hospital costs with reimbursement received for patients undergoing the Norwood procedure for hypoplasia of the left heart. Cardiol Young 2005; 15: 493–497.Google Scholar
6. Dalton, HJ, Tucker, D. Resuscitation and extracorporeal life support during cardiopulmonary resuscitation following the Norwood (Stage 1) operation. Cardiol Young 2011; 21 (Suppl 2): 101–108.Google Scholar
7. Mascio, CE, Austin, EH, Jacobs, JP, et al. Perioperative mechanical support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2014; 147: 658–665.Google Scholar
8. Sherwin, ED, Gauvreau, K, Scheurer, MA, et al. Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2012; 144: 1337–1343.Google Scholar
9. Polimenakos, AC, Wojtyla, P, Smith, PJ, et al. Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes. Eur J Cardiothorac Surg 2011; 40: 1396–1405.Google Scholar
10. Kogon, BE, Ramaswamy, V, Todd, K, et al. Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis 2007; 2: 332–337.Google Scholar
11. Davies, RR, Carver, SW, Schmidt, R, Keskemy, H, Hoch, J, Pizarro, C. Gastrointestinal complications after stage I Norwood versus hybrid procedures. Ann Thorac Surg 2013; 95: 189–195.Google Scholar
12. Averin, K, Uzark, K, Beekman, RH, Willging, JP, Pratt, J, Manning, PB. Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation. Ann Thorac Surg 2012; 94: 1257–1261.Google Scholar
13. Golbus, JR, Wojcik, BM, Charpie, JR, Hirsch, JC. Feeding complications in hypoplastic left heart syndrome after the Norwood procedure: a systematic review of the literature. Pediatr Cardiol 2011; 32: 539–552.Google Scholar
14. Braudis, NJ, Curley, MA, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatr Crit Care Med 2009; 10: 460–466.CrossRefGoogle ScholarPubMed
15. del Castillo, SL, McCulley, ME, Khemani, RG, et al. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 2010; 11: 373–377.Google Scholar
16. Srinivasan, C, Sachdeva, R, Morrow, WR, et al. Standardized management improves outcomes after the Norwood procedure. Congenit Heart Dis 2009; 4: 329–337.Google Scholar
17. Jeffries, HE, Wells, WJ, Starnes, VA, Wetzel, RC, Moromisato, DY. Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2006; 81: 982–987.Google Scholar
18. Patel, A, Hickey, E, Mavroudis, C, et al. Impact of noncardiac congenital and genetic abnormalities on outcomes in hypoplastic left heart syndrome. Ann Thorac Surg 2010; 89: 1805–1813.Google Scholar
19. Wernovsky, G. The paradigm shift toward surgical intervention for neonates with hypoplastic left heart syndrome. Arch Pediatr Adolesc Med 2008; 162: 849–854.CrossRefGoogle ScholarPubMed
20. Kon, AA. Healthcare providers must offer palliative treatment to parents of neonates with hypoplastic left heart syndrome. Arch Pediatr Adolesc Med 2008; 162: 844–848.Google Scholar
21. Karamichalis, JM, del Nido, PJ, Thiagarajan, RR, et al. Early post-operative severity of illness predicts outcomes after the stage 1 Norwood operation. Ann Thorac Surg 2011; 92: 660–665.CrossRefGoogle Scholar
22. Karamichalis, JM, Thiagarajan, RR, Liu, H, Mamic, P, Gauvreau, K, Bacha, EA. Stage 1 Norwood: optimal technical performance improves outcomes irrespective of preoperative physiologic status or case complexity. J Thorac Cadiovasc Surg 2010; 139: 962–968.Google Scholar
23. Bacha, EA, Larrazabal, LA, Pigula, FA, et al. Measurement of technical performance in surgery for congenital heart disease: the stage 1 Norwood procedure. J Thorac Cardiovasc Surg 2008; 136: 993–997.Google Scholar
24. Benavidaz, OJ, Conner, 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.Google Scholar
25. Ioos, V, Galbois, A, Chalumeau-Lemoine, L, Guidet, B, Maury, E, Heiblum, G. An integrated approach for prescribing fewer chest x-rays in the ICU. Ann Intensive Care 2011; 1: 1–9.CrossRefGoogle ScholarPubMed
26. Ganapathy, A, Adhikari, NK, Spiegelman, J, Scales, DC. Routine chest x-rays in intensive care units: a systematic review and meta-analysis. Crit Care 2012; 16: R68.Google Scholar
27. Lehot, JJ, Heuchlin, C, Cartier, R, Neidecker, J, French, P. Streamlining of medical orders in an intensive care unit. Bull Acad Natl Med 2011; 95: 167–178.Google Scholar