Author + information
The adult congenital heart disease population has exceeded the pediatric congenital population with an estimated prevalence of 1.3 million. Adults with congenital heart disease have greater co-morbidities than the general population and accrue significant hospital costs. Defining predictors of high resource use may assist adult hospitals with resource allocation for this growing population. Our objectives include 1) To examine resource use during adult congenital heart surgical admissions in adult hospitals 2) Determine the association of high resource use with complications and mortality and 3) Identify risk factors for high resource use.
Methods and Results
We obtained data from 709 hospitals using the Nationwide Inpatient Sample 2005-2009 and examined Adult Congenital Heart Surgical admissions ages 18–49 years (n=16,231). We defined High Resource Use (HRU) as admissions that exceeded the 90th percentile for total hospital charges; the threshold for HRU was approximately $300,000. Despite representing 10% of admissions, HRU admissions accounted for 68% of total charges. HRU admissions had a higher complication rate than non-HRU (72% vs. 33%, p<0.001) and a higher mortality rate (9.7% vs. 1.8%, P < 0.001). Multivariable analysis demonstrated that HRU is associated with: female gender Adjusted Odds Ratio (AOR) 0.9 (95% confidence interval [Cl] 0.7,1.0); government insurance AOR 2 (95% Cl 1.6, 2.4); weekend admission AOR 1.3 (95% Cl 1, 1.6), emergency admissions AOR 3.9 (95%CI 3.1, 4.8); urgent admissions AOR 2.2 (95% Cl 1.7, 2.9); complications AOR 4.3 (95% Cl 3.4, 5.4); renal failure AOR 1.8 (95%CI 1.5, 2.2); surgical complexity risk category 2 AOR 1.9 (95% Cl 1.1, 3.6); category 3+ AOR 2.3 (95% Cl 1.4, 3.7).
High resource use admissions consumed a disproportionate amount of resources and were associated with higher complication rates and mortality. HRU risk factors included gender, weekend admissions, non-elective admissions, government insurance, increasing surgical complexity, renal failure and complications. Complications, if preventable, may be a target for care improvement strategies to decrease resource use in this population.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: New Insights into Congenital Heart Disease in the Adult
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1249M-139
- 2013 American College of Cardiology Foundation