title: Impact of postoperative complications on hospital costs following the Norwood operation.
abstract: Introduction Patients undergoing the Norwood operation consume considerable healthcare resources; however, detailed information regarding factors impacting hospitalisation costs is lacking. We evaluated the association of postoperative complications with hospital costs.
  
  
  METHODS
  In the present study, we utilised a unique data set consisting of prospectively collected clinical data from the Pediatric Heart Network Single Ventricle Reconstruction trial linked at the patient level with cost data for 10 hospitals participating in the Children's Hospital Association Case Mix database during the trial period. The relationship between complications and cost was modelled using linear regression, accounting for the skewed distribution of cost, adjusting for within-centre clustering and baseline patient characteristics.
  
  
  RESULTS
  A total of 334 eligible Norwood records (97.5%) were matched between data sets. Overall, 82% suffered from at least one complication (median 2; with a range from 0 to 33). Those with complications had longer postoperative length of stay (25 versus 12 days, p<0.001), more total ventilator days (7 versus 5 days, p<0.001), and higher in-hospital mortality (17.6 versus 3.4%, p<0.006). Mean adjusted hospital cost in those with a complication was $190,689 (95% CI $111,344-$326,577) versus $120,584 (95% CI $69,246-$209,983) in those without complications (p=0.002). Costs increased with the number of complications (1-2 complications=$132,800 versus 3-4 complications=$182,353 versus ⩾5 complications=$309,372 [p<0.001]).
  
  
  CONCLUSIONS
  This merged data set of clinical trial and cost data demonstrated that postoperative complications are common following the Norwood operation and are associated with worse clinical outcomes and higher costs. Efforts to reduce complications in this population may lead to improved outcomes and cost savings.
authors.affiliation: 1Medical University of South Carolina,Charleston,South Carolina,United States of America.
authors.forename: Kimberly E
authors.identifier: http://orcid.org/0000-0001-8329-5411
authors.initials: KE
authors.lastname: McHugh
authors.affiliation: 2University of Michigan CS Mott Children's Hospital,Ann Arbor,Michigan,United States of America.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: 3Children's Hospital Association,Overland Park,Kansas,United States of America.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Hall
authors.affiliation: 1Medical University of South Carolina,Charleston,South Carolina,United States of America.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Scheurer
mesh_terms: D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007902:Length of Stay; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D011296:Prenatal Diagnosis; D016896:Treatment Outcome; D014481:United States
keywords: Norwood operation; complications; hypoplastic left heart syndrome; resource utilisation