title: Predicting economic and medical outcomes based on risk adjustment for congenital heart surgery classification of pediatric cardiovascular surgical admissions.
abstract: The Risk Adjustment for Congenital Heart Surgery (RACHS-1) classification is an established method for predicting mortality for congenital heart disease surgery. It is unknown if this extends to the cost of hospitalization or if differences in economic and medical outcomes exist in certain subpopulations. Using data obtained from the University HealthSystem Consortium, we examined inpatient resource use by patients with International Classification of Diseases, Ninth Revision, procedure codes representative of RACHS-1 classifications 1 through 5 and 6 from 2006 to 2012. A total of 15,453 pediatric congenital heart disease surgical admissions were analyzed, with overall mortality of 4.5% (n = 689). As RACHS-1 classification increased, the total cost of hospitalization, hospital charges, total length of stay, length of intensive care unit stay, and mortality increased. Even when controlled for RACHS-1 classification, black patients (n = 2034) had higher total costs ($96,884 ± $3,392, p = 0.003), higher charges ($318,313 ± $12,018, p <0.001), and longer length of stay (20.4 ± 0.7 days, p <0.001) compared with white patients ($85,396 ± $1,382, $285,622 ± $5,090, and 18.0 ± 0.3 days, respectively). Hispanic patients had similarly disparate outcomes ($104,292 ± $2,759, $351,371 ± $10,627, and 23.0 ± 0.6 days, respectively) and also spent longer in the intensive care unit (14.9 ± 0.5 days, p <0.001). In conclusion, medical and economic measures increased predictably with increased procedure risk, and admissions for black and Hispanic patients were longer and more expensive than those of their white counterparts but without increased mortality.
authors.affiliation: Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia. Electronic address: frank.raucci@louisville.edu.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Raucci
authors.affiliation: Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia; Division of Pediatric Cardiology, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Tracey R
authors.initials: TR
authors.lastname: Hoke
authors.affiliation: Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia; Division of Pediatric Cardiology, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Howard P
authors.initials: HP
authors.lastname: Gutgesell
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000191:economics / Q000401:mortality / Q000601:surgery*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D020379:Risk Adjustment; D018570:Risk Assessment; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data