Transesophageal pacing studies reduce readmission but prolong initial admission in infants with supraventricular tachycardia: A cost-comparison analysis

Abstract

Background: Supraventricular tachycardia (SVT) is a common arrhythmia. Infants with SVT are often admitted to initiate antiarrhythmics. Transesophageal pacing (TEP) studies can be used to guide therapy prior to discharge.

Objective: The objective of this study was to investigate the impact of TEP studies on length of stay (LOS), readmission, and cost in infants with SVT.

Methods: This was a 2-site retrospective review of infants with SVT. One site (Center TEPS) utilized TEP studies in all patients. The other (Center NOTEP) did not. Patients with structural heart disease, patients with gestational age <34 weeks, and patients diagnosed after 6 months were excluded. At Center TEPS, repeat TEP studies were performed after titration of medication until SVT was not inducible. Primary endpoints were LOS and readmission for breakthrough SVT within 31 days of discharge. Hospital reimbursement data were utilized for cost-effectiveness analysis.

Results: The cohort included 131 patients, 59 in Center TEPS and 72 in Center NOTEP. One patient was readmitted in Center TEPS vs 17 in Center NOTEP (1.6% vs 23.6%; P ≤ .001). Median LOS was longer for Center TEPS at 118.0 (interquartile range [IQR] 74.0-189.5) hours vs Center NOTEP at 66.9 (IQR 45.5-118.3) hours (P = .001). Twenty-one patients had multiple TEP studies. Median length of readmission for Center NOTEP was 65 (IQR 41-101) hours. Including readmission costs, utilization of TEP studies resulted in a probability-weighted cost of $45,531 per patient compared with $31,087 per patient without TEP studies.

Conclusion: Utilization of TEP studies was associated with decreased readmission rates but longer LOS and greater cost compared with SVT management without TEP studies.

Keywords: Cost; Hospital readmission; Pediatric electrophysiology; Supraventricular tachycardia; Transesophageal pacing.

Figure 1

Bar graph demonstrating the number of transesophageal pacing (TEP) studies received by each patient at Center TEPS. The x-axis represents the number of TEP studies performed, while the y-axis is the number of patients who received that many TEP studies.

Figure 2

Kaplan-Meier curve of freedom from readmission of supraventricular tachycardia patients. The red dashed line represents patients at the center with transesophageal pacing studies (Center TEPS), while the green dotted line represents patients at the center with no transesophageal pacing studies (Center NOTEP). The solid blue line is the overall cohort. Shaded areas are 95% confidence intervals.