Admission to dedicated pediatric cardiac intensive care units is associated with decreased resource use in neonatal cardiac surgery

Abstract

Objective: Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality.

Methods: We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004 and 2013 by using the Pediatric Health Information Systems database (44 children's hospitals). Multivariate generalized estimating equations adjusted for center- and patient-specific risk factors and stratified by age at admission were performed to examine the association of admission intensive care unit (ICU) with total hospital costs, mortality, and length of stay.

Results: Of 19,984 neonates (60% male) identified, 39% were initially admitted to a cardiac ICU (CICU), 48% to a neonatal ICU (NICU), and 13% to a pediatric ICU. In adjusted models, admission to a CICU versus NICU was associated with a $20,440 reduction in total hospital cost for infants aged 2 to 7 days at admission (P = .007) and a $23,700 reduction in total cost for infants aged 8 to 14 days at admission (P = .01). Initial admission to a CICU or pediatric ICU versus NICU at <15 days of age was associated with shorter hospital and ICU length of stay and fewer days of mechanical ventilation. There was no difference in adjusted mortality by admission location.

Conclusions: Admission to an ICU specializing in cardiac care is associated with significantly decreased hospital costs and more efficient resource use for neonates requiring cardiac surgery.

Keywords: intensive care unit; neonatal congenital heart disease; resource use; surgical repair.

Figure 1

Diagram of cohort inclusion

Figure 1

Adjusted estimated mean of total hospital cost by unit of admission stratified by age at admission. Blue – CICU, Green – PICU, Red – NICU admission. NS = Not significant, *p<0.05, †p<0.01, ‡p≤0.001 for comparison to NICU as referent.

Figure 2

Adjusted comparison of difference in charge by category and admission location. For each category, data for CICU and PICU relative to NICU (referent) is displayed. Solid bars- CICU, Open bars – PICU. Blue 0–1 days of age at admission, Red 2–7 days of age at admission, Green 8–14 days of age at admission

Central picture

Resource use decreases with CICU admission in neonatal heart surgery (modeled figure).

Video

Dr. Joyce Johnson, MD MS describes the key findings and relevance of this multicenter observational study.