Author + information
- Kathleen Ryan,
- Claudia Algaze,
- Charlotte Sakarovitch,
- Thomas Do,
- Vamsi Yarlagadda,
- Susan Fernandes,
- Doff McElhinney,
- Stephen Roth,
- Catherine Krawczeski and
- Andrew Shin
Background: Recent studies have shown public health insurance (HI) programs are associated with worse postoperative outcomes among pediatric surgical patients. We aimed to determine if this relationship exists among children undergoing congenital heart surgery.
Methods: Children undergoing congenital heart surgery between January 1, 2012 and December 31, 2013 were identified within the Pediatric Health Information System database. All patients aged <21 years undergoing congenital heart surgery classifiable by Risk Adjustment in Congenital Heart Surgery (RACHS-1) score were included. We evaluated the risk-adjusted association between HI type and in-hospital mortality and hospital length of stay (LOS) using multivariable hierarchical regression models. We adjusted for variables selected based upon expected clinical risk or potential confounding effect [RACHS-1, race, ethnicity, gender, age, baseline complex chronic condition (CCC) and Pediatric Medical Complexity Algorithm].
Results: We analyzed 15,696 pediatric cardiac surgical admissions. Patients with public insurance (n=7272, 46%) were more likely to be younger (14 [4,55] vs 23 [4,84] months, p<0.001), Hispanic (26% vs 7%, p<0.001), non-white (49.3% vs 37.5%, p<0.001) and have CCC (Gastrointestinal 10.7% vs 7.0%; Hematologic or Immunologic 4.3% vs 3.2%; metabolic 2.9% vs 2.1%; respiratory 4.5% vs 3.6%, p<0.001). The risk-adjusted odds ratio for in-hospital mortality was not significant (OR=1.59, p=0.086). The mean LOS among public HI patients was 9.5 (±12.4) days and 8.0 (±9.8) days among private (p=0.001). Children with public HI had longer adjusted LOS (β=0.69 days, p<0.001).
Conclusions: Despite disparities in other pediatric surgical procedures, we found no difference in mortality based on primary payer status in children undergoing congenital heart surgery. We did find children with public HI were more likely to have CCC. Nonetheless, adjusted risk analysis showed that public insurance programs were associated with longer hospital duration.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 4:00 p.m.-4:10 p.m.
Session Title: Predicting Outcomes in Pediatric Heart Disase
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1171M-05
- 2017 American College of Cardiology Foundation