title: Transcatheter Versus Surgical Closure of Atrial Septal Defects in Children: A Value Comparison.
abstract: OBJECTIVE
  The purpose of this study was to determine whether a transcatheter procedure or surgical closure offers a better value proposition for atrial septal defect (ASD) closure.
  
  
  BACKGROUND
  Secundum ASDs are common congenital heart defects with both transcatheter and surgical treatment options. Although both options have been shown to have excellent results in children, the relative value of the 2 procedures is unclear.
  
  
  METHODS
  Using data from the Pediatric Hospital Information System for 2004 to 2012, we compared the value of transcatheter versus surgical ASD closure for children ages 1 to 17 years, with value being defined as outcomes relative to costs. Total charges for procedure-related encounters were converted to costs using hospital-specific cost-to-charge ratios, and all costs were adjusted for inflation to reflect 2012 dollars.
  
  
  RESULTS
  There were 4,606 transcatheter procedures and 3,159 surgeries at 35 children's hospitals. Those undergoing transcatheter closure were more likely to be older (5.6 years vs. 4.5 years, p < 0.0001). There was no mortality in either group. Children with a surgical procedure had a longer length of stay (4.0 days vs. 1.5 days, p < 0.0001), were more likely to have an infection (odds ratio: 3.73, p < 0.0001) or procedural complication (odds ratio: 6.66, p < 0.0001). Costs for transcatheter procedure encounters were lower than costs for surgical encounters (mean of $19,128 vs. $25,359, p < 0.0001).
  
  
  CONCLUSIONS
  Both transcatheter and surgical ASD closure had excellent short-term outcomes, but transcatheter procedures had lower lengths of stay, rates of infection, and complications, resulting in lower overall costs. For children who are eligible, transcatheter ASD closure provides better short-term value than surgery.
authors.affiliation: Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. Electronic address: ooiy@kidsheart.com.
authors.forename: Yinn Khurn
authors.initials: YK
authors.lastname: Ooi
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelleman
authors.affiliation: Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ehrlich
authors.affiliation: Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Glanville
authors.affiliation: Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Arlene
authors.initials: A
authors.lastname: Porter
authors.affiliation: Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Brian
authors.initials: B
authors.lastname: Kogon
authors.affiliation: Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000191:economics / Q000601:surgery / Q000628:therapy*; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial septal defect; outcome; surgery; transcatheter; value