BACKGROUND: This study evaluates the relationship of morbidity and resource utilization with the timing of early neonatal repair of transposition of the great arteries and intact ventricular septum (d-TGA/IVS). METHODS: All patients with d-TGA/IVS who underwent arterial switch in the first 14 days of life, between January 2000 and May 2011, were reviewed. Patients undergoing repair at ≤ 4 days of age were categorized as group I, 5 to 7 days as group II, and 8 to 14 days as group III. Outcomes included mortality, morbidity, and resource utilization. RESULTS: Hospital survival was 69 (98.6%) of 70. The length of stay (LOS) and total charges were lowest in group I--15.5 days compared to group II--18.0 days and group III--23.5 days (P = .005); group I--US$128,219 compared to group II--US$141,729 and group III--US$217,427 (P = .0006). Using regression analysis to account for potentially confounding effects of multiple variables and treating time as a continuous variable demonstrated that age at surgery was significantly associated with total LOS (P = .029), hospital charges (P = .029) and intensive care unit charges (P = .002). Younger age at repair was not associated with worse outcomes for any measure of morbidity. CONCLUSIONS: Earlier repair of d-TGA/IVS was associated with decreased resource utilization and no detriment to clinical outcomes. Further analysis based on a larger cohort of patients is needed to verify these results that have important implications for improving the value of care.
BACKGROUND: This study evaluates the relationship of morbidity and resource utilization with the timing of early neonatal repair of transposition of the great arteries and intact ventricular septum (d-TGA/IVS). METHODS: All patients with d-TGA/IVS who underwent arterial switch in the first 14 days of life, between January 2000 and May 2011, were reviewed. Patients undergoing repair at ≤ 4 days of age were categorized as group I, 5 to 7 days as group II, and 8 to 14 days as group III. Outcomes included mortality, morbidity, and resource utilization. RESULTS: Hospital survival was 69 (98.6%) of 70. The length of stay (LOS) and total charges were lowest in group I--15.5 days compared to group II--18.0 days and group III--23.5 days (P = .005); group I--US$128,219 compared to group II--US$141,729 and group III--US$217,427 (P = .0006). Using regression analysis to account for potentially confounding effects of multiple variables and treating time as a continuous variable demonstrated that age at surgery was significantly associated with total LOS (P = .029), hospital charges (P = .029) and intensive care unit charges (P = .002). Younger age at repair was not associated with worse outcomes for any measure of morbidity. CONCLUSIONS: Earlier repair of d-TGA/IVS was associated with decreased resource utilization and no detriment to clinical outcomes. Further analysis based on a larger cohort of patients is needed to verify these results that have important implications for improving the value of care.
Entities:
Keywords:
congenital heart disease; great vessel anomaly; neonate; outcomes
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: Shada Al Anani; Ibtihaj Fughhi; Anas Taqatqa; Chawki Elzein; Michel N Ilbawi; Anastasios C Polimenakos Journal: Pediatr Cardiol Date: 2016-12-19 Impact factor: 1.655
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