Hospital Costs Related to Early Extubation After Infant Cardiac Surgery

Abstract

Background: The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation rates after infant tetralogy of Fallot (TOF) and coarctation of the aorta (CoA) repair across participating sites by implementing a clinical practice guideline (CPG). The impact of the CPG on hospital costs has not been studied.

Methods: PHN CLS clinical data were linked to cost data from Children's Hospital Association by matching on indirect identifiers. Hospital costs were evaluated across active and control sites in the pre- and post-CPG periods using generalized linear mixed-effects models. A difference-in-difference approach was used to assess whether changes in cost observed in active sites were beyond secular trends in control sites.

Results: Data were successfully linked on 410 of 428 eligible patients (96%) from four active and four control sites. Mean adjusted cost per case for TOF repair was significantly reduced in the post-CPG period at active sites ($42,833 vs $56,304, p < 0.01) and unchanged at control sites ($47,007 vs $46,476, p = 0.91), with an overall cost reduction of 27% in active versus control sites (p = 0.03). Specific categories of cost reduced in the TOF cohort included clinical (-66%, p < 0.01), pharmacy (-46%, p = 0.04), lab (-44%, p < 0.01), and imaging (-32%, p < 0.01). There was no change in costs for CoA repair at active or control sites.

Conclusions: The early extubation CPG was associated with a reduction in hospital costs for infants undergoing repair of TOF but not CoA. This CPG represents an opportunity to both optimize clinical outcome and reduce costs for certain infant cardiac surgeries.

Fig 1.

Categories of cost for tetralogy of Fallot repair. Specific categories of cost in the tetralogy of Fallot cohort are displayed, with percent change from pre-CPG to post-CPG on the y-axis. Standard cost categories included clinical, pharmacy, imaging, laboratory, supplies, and “other.” The “other” category is primarily composed of room and board costs. Notable for the present study, the clinical category contains costs related to mechanical ventilation and other respiratory care. There was a significant reduction in clinical, pharmacy, laboratory, and imaging costs, whereas supply and other costs remained unchanged. (CPG = clinical practice guideline.)