Author + information
- Susan M. Fernandes,
- Lisa Chamberlain,
- Stafford Grady,
- Jonathan Mayo,
- Alexander Optowsky,
- Lee M. Sanders and
- Paul H. Wise
2008 ACC/AHA Guidelines for the management of adults with congenital heart disease (CHD) recommend cardiac surgery for moderate/complex CHD be performed in an adult CHD (ACHD) center (Ctr). Given this, we sought to determine the proportion and predictors of ACHD cardiac surgery performed at ACHD Ctrs.
This study used California's Office of Statewide Health Planning and Development discharge database to perform a retrospective population analysis of ACHD cardiac surgery (>21 years of age) in California (CA) between 2000 and 2009. Center type (ACHD Ctr vs. non-ACHD Ctr) was defined based on a national, volunteer clinical directory. We examined the relationship between Ctr type and mortality, length of stay (LOS), and hospital charges.
There were 5,811 ACHD cardiac surgeries performed in CA between 2000-2009. Only 28% of hospital discharges; 37% of moderate/complex discharges were from ACHD Ctrs. There was no difference in hospital mortality by Ctr type (ACHD ctr=0.6% vs non-ACHD Ctr=0.9%, p=0.125). Median LOS was longer in ACHD Ctrs [6 days (IQR 4-8) vs 5 days (IQR 4-8), p=0.045]. Median total charges were lower for ACHD Ctrs [$127,712 (IQR $83,439-$196,426) vs $138,081 (IQR $89,967-$200,969), p=0.0033] as well as the hospital charges per day ($21,477 [IQR $15,337-$30,572] vs $24,155 (IQR $16,465-$33,455), p<0.0001]. In multivariate analysis, after controlling for disease complexity, the following factors were independently associated with a lower odds of having surgery in an ACHD Ctr: private insurance [AOR 0.61, 95% Cl (0.53-0.70), p=0.004), Hispanic ethnicity [AOR 0.85, 95% Cl (0.72-0.99), p<0.0001] and having >3 medical co-morbidities [AOR 0.75, 95% Cl (0.62-0.92), p=0.0017].
There is profound variation in utilization of ACHD Ctrs in CA. Most ACHD cardiac surgeries are being performed in non-ACHD Ctrs, where expenses and co-morbidity are higher. In addition, non-clinical and clinical factors appear to play an important role in hospitalization patterns of ACHD patients in CA. Understanding these factors is essential in planning for the care needs of this population.
Oral Contributions West, Room 3005
Sunday, March 10, 2013, 11:15 a.m.-11:30 a.m.
Session Title: Congenital Cardiology Solutions: Adult
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 924-5
- 2013 American College of Cardiology Foundation