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Background: Technical performance scores (TPS) have been associated with both clinical outcomes and hospital costs in the congenital heart surgery population. However, the impact of TPS on costs in important subgroups, such as single ventricle patients (who account for the highest costs overall in this population) remains unclear. We evaluated the TPS-cost relationship in a multicenter Norwood cohort.
Methods: Clinical data from the Single Ventricle Reconstruction (SVR) trial were linked with cost data from Children's Hospital Association's CaseMix Database. TPS (optimal, adequate, inadequate) was assigned based on pre-defined criteria using the SVR dataset. The relationship of TPS with hospital costs was modeled, adjusting for baseline patient characteristics. Postoperative complications were also examined.
Results: A total of 266/555 (48%) SVR patients across 9 centers had both TPS and cost data available. Overall, 73% were classified as optimal TPS, 13% adequate, and 14% inadequate. In adjusted analysis, both total costs and the number of complications were more than 2 times higher in those with inadequate vs. optimal TPS (ratio between groups 2.3, 95% CI 1.6-3.3, p<.001, and 2.2, 95% CI 1.4-3.2, p<.001, respectively). Adjusted costs across TPS groups are shown in Figure 1.
Conclusions: Patients with inadequate Norwood TPS had more complications and higher hospital costs. These data suggest efforts geared toward improving TPS may have the potential to improve outcomes and reduce costs of care.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Congenital Heart Disease: Progress in Pediatric Heart Surgery
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1101-018
- 2017 American College of Cardiology Foundation