title: Excess costs associated with complications and prolonged length of stay after congenital heart surgery.
abstract: BACKGROUND
  While there is an increasing emphasis on both optimizing quality of care and reducing health care costs, there are limited data regarding how to best achieve these goals for common and resource-intense conditions such as congenital heart disease. We evaluated excess costs associated with complications and prolonged length of stay (LOS) after congenital heart surgery in a large multicenter cohort.
  
  
  METHODS
  Clinical data from The Society of Thoracic Surgeons Database were linked to estimated costs from the Pediatric Health Information Systems Database (2006 to 2010). Excess cost per case associated with complications and prolonged LOS was modeled for 9 operations of varying complexity adjusting for patient baseline characteristics.
  
  
  RESULTS
  Of 12,718 included operations (27 centers), average excess cost per case in those with any complication (versus none) was $56,584 (+$132,483 for major complications). The 5 highest cost complications were tracheostomy, mechanical circulatory support, respiratory complications, renal failure, and unplanned reoperation or reintervention (ranging from $57,137 to $179,350). Patients with an additional day of LOS above the median had an average excess cost per case of $19,273 (+$40,688 for LOS 4 to 7 days above median). Potential cost savings in the study cohort achievable through reducing major complications (by 10%) and LOS (by 1 to 3 days) were greatest for the Norwood operation ($7,944,128 and $3,929,351, respectively) and several other commonly performed operations of more moderate complexity.
  
  
  CONCLUSIONS
  Complications and prolonged LOS after congenital heart surgery are associated with significant costs. Initiatives able to achieve even modest reductions in these morbidities may lead to both improved outcomes and cost savings across both moderate and high complexity operations.
authors.affiliation: Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan. Electronic address: pasquali@med.umich.edu.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Gaies
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts.
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
mesh_terms: D006348:Cardiac Surgical Procedures / Q000191:economics*; D002675:Child, Preschool; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics* / Q000639:trends; D008297:Male; D011183:Postoperative Complications / Q000191:economics*; D014481:United States