title: Relationship between resource utilization and length of stay following tetralogy of Fallot repair.
abstract: BACKGROUND
  The relationship between resource utilization and postoperative length of stay (PLOS) following congenital heart disease surgery is unknown.
  
  
  METHODS
  We performed a retrospective cohort study using data from the Pediatric Health Information Systems database. We included subjects 1 month to 1 year of age with a PLOS of ≤ 1 month following elective, complete repair of tetralogy of Fallot (TOF) during 2004-2008 at children's hospitals that performed ≥ 10 such surgeries during the study period. We constructed three generalized linear models to assess the relationships of total costs, laboratory costs, and imaging costs during the first three postoperative days with overall PLOS. Race/ethnicity, insurance type, sex, and presence of a genetic syndrome (by ICD-9 codes) were included in the models as fixed effects; hospital of surgery was included as a random effect.
  
  
  RESULTS
  For 1161 eligible surgical encounters at 36 children's hospitals, mean PLOS was 7.1 days (median = 6 days). Mean total, laboratory, and imaging costs for the first three postoperative days were $26,455, $2941, and $813, respectively. Most subjects were male (58.9%), did not have a genetic syndrome (88.3%), were non-Hispanic white (58.3%), and had either public or private insurance (41.0% and 39.1%, respectively). An estimated increase in total costs of $4600 or laboratory costs of $700 in the first three postoperative days was associated with a 1-day increase in PLOS. Imaging costs were not associated with PLOS.
  
  
  CONCLUSIONS
  Increased resource utilization is not associated with a shorter PLOS following elective TOF repair, and it may be associated with longer PLOS.
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, Ga, USA; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.forename: April L
authors.initials: AL
authors.lastname: Dawson
authors.forename: Cara M
authors.initials: CM
authors.lastname: Batenhorst
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Strickland
authors.forename: David G
authors.initials: DG
authors.lastname: Kleinbaum
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D006348:Cardiac Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000191:economics; D017558:Elective Surgical Procedures; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D018803:Models, Economic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome