title: Comparison of clinical outcomes and cost between surgical and transcatheter device closure of atrial septal defects in Singapore children.
abstract: BACKGROUND
  With advances in interventional catheterisation, transcatheter device closure of atrial septal defect (ASD) is now a feasible option to open heart surgery, especially in patients with isolated ASD. We aim to compare the outcomes, benefits and costs between device closure versus standard open-heart surgery for ASD in Singapore.
  
  
  METHODS
  This is a comparative study between 2 cohorts with isolated secundum ASDs who underwent closure of ASD either by surgery or device, at the Department of Paediatrics, National University Hospital (NUH). The clinical outcomes, complications, length of stay and total costs incurred were compared.
  
  
  RESULTS
  Surgical patients were at slightly greater risk of developing complications (RR=1.33; 95% CI, 0.30 to 5.95) than the device group. The median length of inpatient stay for the surgical group was significantly longer than that for the device group. Seventy percent of the patients in the device group did not need to be in ICU while 40% of patients in the surgery group stayed 2 or at least 3 days in ICU (P <0.001). The mean cost per successful procedure was $1511 (95% CI, -352 to 3375) higher for the device group patients despite a shorter length of stay in hospital.
  
  
  CONCLUSIONS
  We concluded that transcatheter device closure is an effective and safe alternative to surgery in the treatment of suitable ASDs. Despite the high cost of the device, direct and indirect benefits for the patients and their families, who undergo device occlusion include less morbidity, better cosmesis, shorter length of stay in hospital, faster recovery and shorter time taken to resume normal activities.
authors.affiliation: Department of Paediatrics, National University Health System, National University of Singapore, Singapore.
authors.forename: Swee Chye
authors.initials: SC
authors.lastname: Quek
authors.forename: Sucharita
authors.initials: S
authors.lastname: Hota
authors.forename: Bee Choo
authors.initials: BC
authors.lastname: Tai
authors.forename: Sandhya
authors.initials: S
authors.lastname: Mujumdar
authors.forename: Mei Yin
authors.initials: MY
authors.lastname: Tok
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D006344:Heart Septal Defects, Atrial / Q000191:economics / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D055989:Septal Occluder Device / Q000191:economics*; D012846:Singapore; D016896:Treatment Outcome; D055815:Young Adult