High Resource Use Ups Congenital Heart Surgery Risk

Higher mortality for high-resource-using adults going for congenital heart surgery in peds hospital

WEDNESDAY, Oct. 19 (HealthDay News) -- Adults with high resource use (HRU) undergoing congenital heart surgery in pediatric hospitals have higher mortality, according to a study published online Oct. 18 in Circulation: Cardiovascular Quality and Outcomes.

Yuli Y. Kim, M.D., from the University of Pennsylvania School of Medicine in Philadelphia, and colleagues examined resource use by patients undergoing adult congenital heart (ACH) surgery in pediatric hospitals, analyzed the association between HRU and inpatient mortality, and identified HRU risk factors. Inpatient data from 2000 to 2008 were collected for 97,563 congenital heart surgery admissions, including 3,061 (3.1 percent) ACH surgery admissions, in 42 pediatric hospitals. Risk factors for HRU admissions, defined as those exceeding 90th percentile for total hospital charges, were evaluated by multivariable analyses.

The investigators found that the ACH surgery admissions accounted for 2.2 percent of total hospital charges. HRU admissions comprised 10 percent of all admissions but accounted for 34 percent of charges for all ACH surgery admissions. The mortality rate differed significantly for HRU admissions (16 percent) versus others (0.7 percent). Risk factors for HRU were identified as DiGeorge syndrome (adjusted odds ratio [aOR], 4.2), depression (aOR, 3.1), weekend admission (aOR, 2.6), government insurance (aOR, 2.0), and higher surgical complexity of risk categories 2, 3, and 4+, compared with risk category 1 (aORs, 3.6, 13.7, and 30.7, respectively).

"High resource use ACH surgery admissions are associated with significantly greater mortality rates," the authors write.

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