Abstract 18981: Regional Variation in Inpatient Hospital Resources Utilized in Cardiac Surgery Performed in Children

Introduction: Care for congenital heart disease is highly resource-intensive due to its complexity, and due to patients’ need for surgery and other inpatient care. Understanding regional variation in resource utilization for cardiac surgical care can promote collaborative learning opportunities that could help optimize resources for patient-centered care.

Methods: This cross-sectional analysis used the nationally representative 2012 Kids’ Inpatient Database, managed by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Based on International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, we identified hospital discharges of cardiac surgery patients under 18 years of age. We excluded patients undergoing cardiac transplantation and newborns under 31 days of age who only underwent ligation of isolated patent ductus arteriosus. Included cases were aggregated based on the nine US geographic divisions used by the US Census Bureau. Regional variation in observed inpatient billed charges, estimated hospital costs based on cost-to-charge ratios and inpatient length of stay (LOS) were analyzed. The log transformed outcomes were compared unadjusted, and after adjusting for RACHS-1 inpatient surgical mortality risk, admission type, expected primary payer and coded complications (as appropriate).

Results: Among 15,350 analyzed discharges, the mean nationwide adjusted in-hospital mortality was 3%. It was highest in East South Central (5%). However, the differences among divisions were not significant for all RACHS-1 categories. Mean adjusted complications frequencies ranged from 21 to 32%.LOS showed only minor variations across divisions. Median billed hospital charges ranged from $93,869 to $226,061. For all RACHS-1 categories, New England (lowest) and East North Central had significantly lower charges than did the Mid-Atlantic division. Estimated costs were significantly lower than charges, ranging from $44,402 to $66,726 across all divisions. Costs were lowest in the Mid-Atlantic division.

Conclusions: There is regional variation in resource utilization in cardiac surgical care for CHD with no observed correlation with LOS, case mix or complications.