Yinn Khurn Ooi1, Michael Kelleman2, Alexandra Ehrlich3, Michelle Glanville3, Arlene Porter3, Dennis Kim4, Brian Kogon4, Matthew E Oster4. 1. Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Electronic address: ooiy@kidsheart.com. 2. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 3. Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia. 4. Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Abstract
OBJECTIVES: The purpose of this study was to determine whether a transcatheter procedure or surgical closure offers a better value proposition for atrial septal defect (ASD) closure. BACKGROUND: Secundum ASDs are common congenital heart defects with both transcatheter and surgical treatment options. Although both options have been shown to have excellent results in children, the relative value of the 2 procedures is unclear. METHODS: Using data from the Pediatric Hospital Information System for 2004 to 2012, we compared the value of transcatheter versus surgical ASD closure for children ages 1 to 17 years, with value being defined as outcomes relative to costs. Total charges for procedure-related encounters were converted to costs using hospital-specific cost-to-charge ratios, and all costs were adjusted for inflation to reflect 2012 dollars. RESULTS: There were 4,606 transcatheter procedures and 3,159 surgeries at 35 children's hospitals. Those undergoing transcatheter closure were more likely to be older (5.6 years vs. 4.5 years, p < 0.0001). There was no mortality in either group. Children with a surgical procedure had a longer length of stay (4.0 days vs. 1.5 days, p < 0.0001), were more likely to have an infection (odds ratio: 3.73, p < 0.0001) or procedural complication (odds ratio: 6.66, p < 0.0001). Costs for transcatheter procedure encounters were lower than costs for surgical encounters (mean of $19,128 vs. $25,359, p < 0.0001). CONCLUSIONS: Both transcatheter and surgical ASD closure had excellent short-term outcomes, but transcatheter procedures had lower lengths of stay, rates of infection, and complications, resulting in lower overall costs. For children who are eligible, transcatheter ASD closure provides better short-term value than surgery.
OBJECTIVES: The purpose of this study was to determine whether a transcatheter procedure or surgical closure offers a better value proposition for atrial septal defect (ASD) closure. BACKGROUND: Secundum ASDs are common congenital heart defects with both transcatheter and surgical treatment options. Although both options have been shown to have excellent results in children, the relative value of the 2 procedures is unclear. METHODS: Using data from the Pediatric Hospital Information System for 2004 to 2012, we compared the value of transcatheter versus surgical ASD closure for children ages 1 to 17 years, with value being defined as outcomes relative to costs. Total charges for procedure-related encounters were converted to costs using hospital-specific cost-to-charge ratios, and all costs were adjusted for inflation to reflect 2012 dollars. RESULTS: There were 4,606 transcatheter procedures and 3,159 surgeries at 35 children's hospitals. Those undergoing transcatheter closure were more likely to be older (5.6 years vs. 4.5 years, p < 0.0001). There was no mortality in either group. Children with a surgical procedure had a longer length of stay (4.0 days vs. 1.5 days, p < 0.0001), were more likely to have an infection (odds ratio: 3.73, p < 0.0001) or procedural complication (odds ratio: 6.66, p < 0.0001). Costs for transcatheter procedure encounters were lower than costs for surgical encounters (mean of $19,128 vs. $25,359, p < 0.0001). CONCLUSIONS: Both transcatheter and surgical ASD closure had excellent short-term outcomes, but transcatheter procedures had lower lengths of stay, rates of infection, and complications, resulting in lower overall costs. For children who are eligible, transcatheter ASD closure provides better short-term value than surgery.
Authors: Michael L O'Byrne; Russell T Shinohara; Elena K Grant; Joshua P Kanter; Matthew J Gillespie; Yoav Dori; Jonathan J Rome; Andrew C Glatz Journal: Am Heart J Date: 2017-07-19 Impact factor: 4.749
Authors: Bryan H Goldstein; Michael L O'Byrne; Christopher J Petit; Athar M Qureshi; Dingwei Dai; Heather M Griffis; Ashton France; Michael S Kelleman; Courtney E McCracken; Christopher E Mascio; Subi Shashidharan; R Allen Ligon; Wendy Whiteside; W Jack Wallen; Hitesh Agrawal; Varun Aggarwal; Andrew C Glatz Journal: Circ Cardiovasc Interv Date: 2019-04 Impact factor: 6.546
Authors: Bryan H Goldstein; Christopher J Petit; Athar M Qureshi; Courtney E McCracken; Michael S Kelleman; George T Nicholson; Mark A Law; Jeffery J Meadows; Jeffrey D Zampi; Shabana Shahanavaz; Christopher E Mascio; Paul J Chai; Jennifer C Romano; Sarosh P Batlivala; Shiraz A Maskatia; Ivor B Asztalos; Alicia M Kamsheh; Steven J Healan; Justin D Smith; R Allen Ligon; Joelle A Pettus; Sarina Juma; James E B Raulston; Krissie M Hock; Amy L Pajk; Lindsay F Eilers; Hala Q Khan; Taylor C Merritt; Matthew Canter; Stephan Juergensen; Fatuma-Ayaan Rinderknecht; Holly Bauser-Heaton; Andrew C Glatz Journal: J Am Coll Cardiol Date: 2021-03-02 Impact factor: 24.094