Brett R Anderson1, Adam J Ciarleglio2, Denise A Hayes1, Jan M Quaegebeur3, Julie A Vincent1, Emile A Bacha4. 1. Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital Columbia University Medical Center, New York, New York. 2. Department of Biostatistics, Columbia University, New York, New York. 3. Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York. 4. Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: eb2709@columbia.edu.
Abstract
OBJECTIVES: This study sought to examine the impact of surgical timing on major morbidity and hospital reimbursement for late preterm and term infants with dextrotransposition of the great arteries (d-TGA). BACKGROUND: Neonatal arterial switch operation is the standard of care for d-TGA. Little is known about the effects of age at operation on clinical outcomes or costs for these neonates. METHODS: We conducted a retrospective cohort study of infants at ≥36 weeks' gestation, with d-TGA, with or without ventricular septal defects, admitted to our institution at 5 days of age or younger, between January 1, 2003 and October 1, 2012. Children with other cardiac abnormalities or other major comorbid conditions were excluded. Univariable and multivariable analyses were performed to determine the effects of age at operation on major morbidity and hospital reimbursement. RESULTS: A total of 140 infants met inclusion criteria. Reimbursement data were available for them through January 1, 2012 (n = 128). The mortality rate was 1.4% (n = 2). Twenty percent (n = 28) experienced a major morbidity. The median costs were $60,000, in 2012 dollars (range: $25,000 to $549,000). The median age at operation was 5 days (range: 1 to 12 days). For every day later that surgery was performed, beyond day of life 3, the odds of major morbidity increased by 47% (range: 23% to 66%, p < 0.001) and costs increased by 8% (range: 5% to 11%, p < 0.001), after considering the effects of sex, birth weight, gestational age, year at which surgery was performed, transfer, weekend admission, insurance, surgeon, septostomy, bypass and cross-clamp times, and the presence of ventricular septal defects or abnormal coronary anatomy. CONCLUSIONS: Delay of neonatal arterial switch operation beyond 3 days is significantly associated with increased morbidity and healthcare costs.
OBJECTIVES: This study sought to examine the impact of surgical timing on major morbidity and hospital reimbursement for late preterm and term infants with dextrotransposition of the great arteries (d-TGA). BACKGROUND: Neonatal arterial switch operation is the standard of care for d-TGA. Little is known about the effects of age at operation on clinical outcomes or costs for these neonates. METHODS: We conducted a retrospective cohort study of infants at ≥36 weeks' gestation, with d-TGA, with or without ventricular septal defects, admitted to our institution at 5 days of age or younger, between January 1, 2003 and October 1, 2012. Children with other cardiac abnormalities or other major comorbid conditions were excluded. Univariable and multivariable analyses were performed to determine the effects of age at operation on major morbidity and hospital reimbursement. RESULTS: A total of 140 infants met inclusion criteria. Reimbursement data were available for them through January 1, 2012 (n = 128). The mortality rate was 1.4% (n = 2). Twenty percent (n = 28) experienced a major morbidity. The median costs were $60,000, in 2012 dollars (range: $25,000 to $549,000). The median age at operation was 5 days (range: 1 to 12 days). For every day later that surgery was performed, beyond day of life 3, the odds of major morbidity increased by 47% (range: 23% to 66%, p < 0.001) and costs increased by 8% (range: 5% to 11%, p < 0.001), after considering the effects of sex, birth weight, gestational age, year at which surgery was performed, transfer, weekend admission, insurance, surgeon, septostomy, bypass and cross-clamp times, and the presence of ventricular septal defects or abnormal coronary anatomy. CONCLUSIONS: Delay of neonatal arterial switch operation beyond 3 days is significantly associated with increased morbidity and healthcare costs.
Authors: Michael Salna; Paul J Chai; David Kalfa; Yuki Nakamura; Ganga Krishnamurthy; Jan M Quaegebeur; Marc Najjar; Amee Shah; Stephanie Levasseur; Brett R Anderson; Emile A Bacha Journal: Semin Thorac Cardiovasc Surg Date: 2018-04-02
Authors: Michael L O'Byrne; Andrew C Glatz; Lihai Song; Heather M Griffis; Marisa E Millenson; Matthew J Gillespie; Yoav Dori; Aaron G DeWitt; Christopher E Mascio; Jonathan J Rome Journal: Circulation Date: 2018-11-06 Impact factor: 29.690
Authors: Juan Villafañe; M Regina Lantin-Hermoso; Ami B Bhatt; James S Tweddell; Tal Geva; Meena Nathan; Martin J Elliott; Victoria L Vetter; Stephen M Paridon; Lazaros Kochilas; Kathy J Jenkins; Robert H Beekman; Gil Wernovsky; Jeffrey A Towbin Journal: J Am Coll Cardiol Date: 2014-08-05 Impact factor: 24.094