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Outcomes and hospital costs associated with the Norwood operation: beyond morbidity and mortality

Published online by Cambridge University Press:  03 November 2014

Brian E. Kogon ,
Kirk Kanter ,
Bahaaldin Alsoufi ,
Kevin Maher  and
Matthew E. Oster
Brian E. Kogon*
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Kirk Kanter
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Bahaaldin Alsoufi
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Kevin Maher
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Matthew E. Oster
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
*
Correspondence to: Dr B. E. Kogon, MD, Emory University, Children’s Healthcare of Atlanta, Egleston, Atlanta, 30322 Georgia, United States of America. Tel: 678 372 7324; Fax: 404 785 6266; E-mail: Bkogon@emory.edu
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Abstract

Background

Although much is known about morbidity and mortality, there are limited data focussing on the financial aspect of the Norwood operation. Our objective is to characterise the hospitalisation and detail the hospital costs.

Methods

We retrospectively studied 86 newborns with hypoplastic left heart syndrome who underwent Norwood palliation between 2008 and 2012. Clinical and financial data were collected. Financial data have been reported for 2011–2012.

Results

At surgery, median age and weight of the patients were 4 days (range 1–13) and 3 kg (range 2–4.8), respectively. The median time from admission to surgery was 4 days (range 1–10), with the postoperative ICU stay and total length of stay at the hospital being 10 days (range 4–135) and 16 days (range 5–136), respectively. Discharge mortality was 14/86 (16%) patients.

For patients operated on between 2011 and 2012 (n=40), median hospital costs, charges, and collections per patient were $117,021, $433,054, and $198,453, respectively, and mean hospital costs, charges, and collections per patient were $322,765, $1,109,500, and $511,271, respectively.

A breakdown of total hospital costs (direct and indirect) by department showed that the top four areas of resource utilisation (excluding physician fees) were as follows: the cardiac ICU (35%), laboratory (12%), pharmacy (12%), and operating room (7%). Interestingly, point-of-care laboratory evaluations accounted for almost half of the laboratory total (5%). Extracorporeal membrane oxygenation, although only utilised in eight patients between 2011 and 2012, accounted for 7% of utilisation.General radiology only accounted for 2%, despite numerous radiographs.

Conclusions

Limited data are available that detail the hospitalisation and costs associated with the Norwood operation. We hope that this analysis will identify areas for quality and value improvement from both system and patient perspectives.

Keywords

Norwoodoutcomeshospital costs
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 853 - 859
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Copyright
© Cambridge University Press 2014 

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