Costs vary widely across hospitals for congenital heart operations

Costs for congenital heart surgery vary across hospitals, with complications and length of stay contributing to more than a quarter of the variation, researchers reported in the March issue of Pediatrics.

Sara K. Pasquali, MD, MHS, of Mott Children’s Hospital in Ann Arbor, Mich., and colleagues conducted a cost analysis by linking data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHD) with data in the Pediatric Health Information Systems (PHIS) database at the patient level. The STS-CHD includes detailed clinical and operative data, including preoperative patient characteristics and information about specific complications. The PHIS is an administrative database that collects information, including resource use, from hospital billings from more than 40 children’s centers in the U.S.

Their goal was to elucidate costs associated with congenital heart disease, a common and resource-intensive condition. They also looked at the association between hospital surgical volume and cost.  

Pasquali et al identified 27 hospitals that between 2006 and 2010 performed 12,718 operations of varying complexity. The nine operations studied were ventricular septal defect (VSD) repair; Tetralogy of Fallot repair; complete atrioventricular canal repair; arterial switch operation; Fontan operation; truncus arteriosus repair; the Norwood operation; atrial septal defect repair and bidirectional Glenn hemi-Fontan.

They estimated cost using hospital- and department-specific cost-to-charge ratios, adjusted and indexed to 2010 dollars.

The median cost per case increased with complexity, ranging from $25,499 for atrial septal defect repair to $165,168 for the Norwood operation. Variability of cost per case also increased with complexity, from 1.2-fold to 9.5-fold across operations. In addition, they found significant between-hospital variation in high and low complexity operations.

Length of stay and complication rates played a role in cost variability. On average, 23 percent of variation in costs between hospitals was due to differences in postoperative length of stay and 28 percent was due to complication rates plus length of stay across operations.

Generally, more complex operations showed higher complication rates. Hospitals with higher costs tended to have longer postoperative length of stay and higher major complication rates. Low- and medium-volume hospitals had higher adjusted odds of increased cost for the most complex operations.

The results provide a benchmark for costs for congenital heart surgeries, Pasquali et al argued, and the variability shows “there is ample room for improvement.”

“Further study is needed to assess which specific complications are associated with the highest costs,” they wrote. “Overall, these data suggest that recent federal initiatives aimed at reducing costs may consider targeting LOS [length of stay] and complications. This type of strategy would have the potential to both improve clinical outcomes and reduce costs.”

They recommended programs use benchmarks to provide feedback to hospitals about their costs and outcomes and develop ways to share best practices. They also suggested studies to identify potential differences in use of imaging and laboratory testing be conducted.