Introduction:
The mortality of infants requiring cardiac surgery is related to center and surgeon case volume. One solution for increasing case volume is to regionalize pediatric cardiac surgical care.
Hypothesis:
We hypothesized that the regionalization of pediatric cardiac surgical care from two medical centers would lower mortality, rate of re-operation, and subsequent health care costs.
Methods:
Infants undergoing a biventricular repair were divided into two groups: pre-regionalization when operations were performed in two separate hospitals (1991-2000) and post-regionalization when all operations were performed in one regional hospital (2001-2010). Operative survival, midterm mortality, need for re-operation, and subsequent healthcare costs were compared between the groups.
Results:
There were 508 infants in the pre-regionalization group, and 479 infants in the post-regionalization group. There were no significant differences in pre-operative age, weight, or gender between groups. Pre-regionalization operative survival was significantly lower than the state average. Post-regionalization operative survival was significantly greater than pre-regionalization and was similar to the state average (Figure 1). Five and 10 year survival remained significantly greater in the post-regionalization group (5 year: 96.8% vs 90.6%, 10 year: 96.8% vs. 89.9%, p<0.01). Five and ten year freedom from re-operation was significantly higher in the post-regionalization group (5 year: 88.8 vs 79.5 %, 10 year: 82.7 vs 73.3%, p=0.001). Subsequent health care costs were significantly lower in the post-regionalization group ($20,233 ± 53596 vs. 37,516 ± 82,947, p<0.001).Conclusions: Regionalization of pediatric cardiac surgical care lowered operative and 10 year mortality, rate of re-operation, and subsequent costs of health care.
Pumping the Breaks on Health Care Costs of Cardiac Surgery by Focusing on Postacute Care Spending
