Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;155(6):2606-2614.e5.
doi: 10.1016/j.jtcvs.2018.01.100. Epub 2018 Feb 21.

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

Joyce T Johnson  1 , Jacob F Wilkes  2 , Shaji C Menon  3 , Lloyd Y Tani  3 , Hsin-Yi Weng  4 , Bradley S Marino  5 , Nelangi M Pinto  3
Affiliations

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

Joyce T Johnson et al. J Thorac Cardiovasc Surg. 2018 Jun.

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.

PubMed Disclaimer

Conflict of interest statement

Potential Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
Diagram of cohort inclusion
Figure 1
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
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
Central picture
Resource use decreases with CICU admission in neonatal heart surgery (modeled figure).
Video
Video
Dr. Joyce Johnson, MD MS describes the key findings and relevance of this multicenter observational study.
See this image and copyright information in PMC

Comment in

References

    1. Russo CA, Elixhauser A. Hospitalizations for birth defects, 2004. HCUP statistical brief #24. 2007 - PubMed
    1. Pasquali SK, Jacobs JP, Bove EL, Gaynor JW, He X, Gaies MG, et al. Quality-cost relationship in congenital heart surgery. Ann Thorac Surg. 2015;100:1416–1421. - PMC - PubMed
    1. Connor JA, Gauvreau K, Jenkins KJ. Factors associated with increased resource utilization for congenital heart disease. Pediatrics. 2005;116:689–695. - PubMed
    1. Smith AH, Gay JC, Patel NR. Trends in resource utilization associated with the inpatient treatment of neonatal congenital heart disease. Congenit Heart Dis. 2014;9:96–105. - PubMed
    1. Chan T, Kim J, Minich LL, Pinto NM, Waitzman NJ. Surgical volume, hospital quality, and hospitalization cost in congenital heart surgery in the united states. Pediatr Cardiol. 2015;36:205–213. - PubMed

MeSH terms