title: Earlier stage 1 palliation is associated with better clinical outcomes and lower costs for neonates with hypoplastic left heart syndrome.
abstract: OBJECTIVE
  Our aim was to examine the effects of surgical timing on major morbidity, mortality, and total hospital reimbursement for late preterm and term infants with hypoplastic left heart syndrome (HLHS) undergoing stage 1 palliation within the first 2 weeks of life.
  
  
  METHODS
  We conducted a retrospective cohort study of infants aged ≥35 weeks gestation, with HLHS, admitted to our institution at age ≤5 days, between January 1, 2003, and January 1, 2013. Children with other cardiac abnormalities or other major comorbid conditions were excluded. Univariable and multivariable analyses were performed to determine the association between age at stage 1 palliation and major morbidity, mortality, and hospital reimbursement.
  
  
  RESULTS
  One hundred thirty-four children met inclusion criteria. Mortality was 7.5% (n = 10). Forty-three percent (n = 58) experienced major morbidity. Median costs were $97,000, in 2013 dollars (interquartile range, $72,000-$151,000). Median age at operation was 5 days (interquartile range, 3-7 days; full range, 1-14 days). All deaths occurred in patients operated on between 4 and 8 days of life. For every day later that surgery was performed, the odds of major morbidity rose by 15.7% (95% confidence interval, 2.5%-30.7%; P = .018) and costs rose by 4.7% (95% confidence interval, 0.9%-8.2%; P < .014).
  
  
  CONCLUSIONS
  Delay of stage 1 palliation for neonates with HLHS is associated with increased morbidity and health care costs, even within the first 2 weeks of life.
authors.affiliation: Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Anderson
authors.affiliation: Division of Biostatistics, Department of Child and Adolescent Psychiatry, New York University, New York, NY.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Ciarleglio
authors.affiliation: Pediatrics Residency Program, NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, NY.
authors.forename: Arash
authors.initials: A
authors.lastname: Salavitabar
authors.affiliation: Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Torres
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: eb2709@cumc.columbia.edu.
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
mesh_terms: D016009:Chi-Square Distribution; D017046:Cost Savings; D005260:Female; D005865:Gestational Age; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007349:Insurance, Health, Reimbursement; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009519:New York City; D016017:Odds Ratio; D010166:Palliative Care / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000191:economics*; D016896:Treatment Outcome