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Hospital costs and cost implications of co-morbid conditions for patients with single ventricle in the period through to Fontan completion

      Abstract

      Background

      Patients undergoing palliative surgeries for single-ventricle conditions are affected by multiple comorbidities or non-cardiac conditions. The prevalence, costs and the cost implications of these conditions have not been assessed.

      Methods

      Administrative costing records from four hospitals in Australia and New Zealand were linked with the Fontan registry database to analyze the inpatient resource use for co-morbid or non-cardiac conditions. Inpatient costing records from the birth year through to Fontan completion were available for 156 patients. The most frequent primary diagnoses were hypoplastic left heart syndrome (33%), double inlet left ventricle (13%), and tricuspid atresia (12%).

      Results

      During the staged surgical treatment period, children had a mean of 10 ± 6 inpatient admissions and spent 85 ± 64 days in hospital. Among these admissions, 3 ± 5 were for non-cardiac conditions, totaling 21 ± 41 inpatient days. Whilst cardiac surgeries were the major reason for resource use (77% of the total cost), other cardiac care that is not surgical contributed 5% and non-cardiac admissions 18% of the total cost. The three most prevalent non-cardiac diagnostic admission categories were ‘Respiratory system’, ‘Digestive system’, and ‘Ear, nose, mouth and throat’, affecting 28%, 21% and 34% of the patients respectively. Multivariate regression estimated that admissions for each of these categories resulted in an increased cost of $34,563 (P = 0.08), $52,438 (P = 0.05) and $10,525 (P = 0.53) per patient respectively for the staged surgical treatment period.

      Conclusions

      Non-cardiac admissions for single-ventricle patients are common and have substantial resource implications. Further research assessing the causes of admission and extent to which admissions are preventable is warranted.

      Keywords

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      References

        • d'Udekem Y.
        • Xu M.Y.
        • Galati J.C.
        • et al.
        Predictors of survival after single-ventricle palliation.
        J. Am. Coll. Cardiol. 2012; 59: 1178-1185
        • Feinstein J.A.
        • Benson D.W.
        • Dubin A.M.
        • et al.
        Hypoplastic left heart syndrome: current considerations and expectations.
        J. Am. Coll. Cardiol. 2012; 59: S1-S42
        • Barron D.J.
        • Kilby M.D.
        • Davies B.
        • Wright J.G.
        • Jones T.J.
        • Brawn W.J.
        Hypoplastic left heart syndrome.
        Lancet. 2009; 374: 551-564
        • Schilling C.
        • Dalziel K.M.
        • Nunn R.
        • et al.
        The Fontan epidemic: population projections from the Australia and New Zealand Fontan Registry.
        Int. J. Cardiol. 2016; 219: 14-19
        • Iyengar A.J.
        • Winlaw D.S.
        • Galati J.C.
        • et al.
        The Australia and New Zealand Fontan Registry: description and initial results from the first population-based Fontan registry.
        Intern. Med. J. 2014; 44: 148-155
      1. Clinical casemix handbook 2012–2014. 2012; http://www.health.wa.gov.au/activity/docs/ABF-ABM_Clinical_Casemix_Handbook_2012-2014.pdf. Accessed 02/09, 2016.

        • Moran J.L.
        • Solomon P.J.
        • Peisach A.R.
        • Martin J.
        New models for old questions: generalized linear models for cost prediction.
        J. Eval. Clin. Pract. 2007; 13: 381-389
        • Glick H.A.
        • Doshi J.A.
        • Sonnad S.S.
        • Polsky D.
        Economic Evaluation in Clinical Trials.
        second ed. 2015
        • Tabtabai S.
        • Yeh D.D.
        • Stefanescu A.
        • Kennedy K.
        • Yeh R.W.
        • Bhatt A.B.
        National trends in hospitalizations for patients with single-ventricle anatomy.
        Am. J. Cardiol. 2015; 116: 773-778
        • Brown M.L.
        • DiNardo J.A.
        • Odegard K.C.
        Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events.
        Paediatr. Anaesth. 2015; 25: 846-851
        • Lassman D.
        • Hartman M.
        • Washington B.
        • Andrews K.
        • Catlin A.
        US health spending trends by age and gender: selected years 2002–10.
        Health Aff. 2014; 33: 815-822
        • Carins T.A.
        • Shi W.Y.
        • Iyengar A.J.
        • et al.
        Long-term outcomes after first-onset arrhythmia in Fontan physiology.
        J. Thorac. Cardiovasc. Surg. 2016; 152: 1355-1363
        • Danford D.A.
        • Karels Q.
        • Kulkarni A.
        • Hussain A.
        • Xiao Y.
        • Kutty S.
        Mortality-related resource utilization in the inpatient care of hypoplastic left heart syndrome.
        Orphanet J. Rare Dis. 2015; 10https://doi.org/10.1186/s13023-015-0355-1