Impact of anatomical subtype and medical comorbidities on hospitalizations in adults with single ventricle congenital heart disease.
BACKGROUND
Most patients with single ventricle congenital heart disease (SV) are now expected to survive to adulthood. Medical comorbidities are common in SV.


METHODS
We used data from 43 pediatric hospitals in the 2004 to 2011 Pediatric Health Information System database to identify patients ≥18 years of age admitted with International Classification of Diseases-9th Revision codes for a diagnosis of either hypoplastic left heart syndrome (HLHS), tricuspid atresia (TA) or common ventricle (CV). Primary (PD) and secondary diagnoses (SD), length of stay (LOS) and hospital charges were determined. Multilevel models were used to evaluate differences in demographics, diagnoses, and admission outcomes among the three subgroups (HLHS, TA, and CV). Interactions of charges with PD and admission year were examined using ANOVA.


RESULTS
There were 801 SV patients with 1330 admissions during the study period. Mean age was 24.8±6.2 years (55% male) and mean LOS was 6.8±11.3 days. Total hospital charges were $135 million with mean charge per admission of $101,131±205,808. The mean charge per day was $15,407±16,437. Hospital charges correlated with PD group (p<0.001). Admission rate remained stable (~180/year) from 2006 to 2011. LOS decreased (p=0.0308) and hospital charges per day increased across the study period (p<0.001). PD was non-cardiac in 28% of admissions. Liver-related conditions were more common in patients with HLHS (p<0.001).


CONCLUSIONS
Hospitalization costs in adults with SV are significant and are impacted by comorbid medical conditions. Hospitalization rates for adults with SV are not increasing. Gastroenterologic comorbidities including protein-losing enteropathy (PLE) are common in HLHS.
The University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, AR, USA; The University of Arkansas for Medical Sciences, Department of Internal Medicine, Little Rock, AR, USA. Electronic address: rtcollins@uams.edu.
R Thomas
RT
Collins
Ricki Y
RY
Fram
Xinyu
X
Tang
James M
JM
Robbins
Martin St John
MS
Sutton
D000328:Adult; D015897:Comorbidity / Q000639:trends; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004066:Digestive System Diseases / Q000191:economics / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D006352:Heart Ventricles / Q000002:abnormalities*; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Adult congenital heart disease; Comorbid medical conditions; Hypoplastic left heart syndrome; Protein-losing enteropathy; Single ventricle