Risk Factors for Increased Hospital Resource Utilization and In-Hospital Mortality in Adults With Single Ventricle Congenital Heart Disease.
Most patients with single ventricle congenital heart disease are now expected to survive to adulthood. Co-morbid medical conditions (CMCs) are common. We sought to identify risk factors for increased hospital resource utilization and in-hospital mortality in adults with single ventricle. We analyzed data from the 2001 to 2011 Nationwide Inpatient Sample database in patients aged ≥18 years admitted to nonteaching general hospitals (NTGHs), TGHs, and pediatric hospitals (PHs) with either hypoplastic left heart syndrome, tricuspid atresia or common ventricle. National estimates of hospitalizations were calculated. Elixhauser CMCs were identified. Length of stay (LOS), total hospital costs, and effect of CMCs were determined. Age was greater in NTGH (41.5 ± 1.3 years) than in TGH (32.8 ± 0.5) and PH (25.0 ± 0.6; p <0.0001). Adjusted LOS was shorter in NTGH (5.6 days) than in PH (9.7 days; p <0.0001). Adjusted costs were higher in PH ($56,671) than in TGH ($31,934) and NTGH ($18,255; p <0.0001). CMCs are associated with increased LOS (p <0.0001) and costs (p <0.0001). Risk factors for in-hospital mortality included increasing age (odds ratio [OR] 5.250, CI 2.825 to 9.758 for 45- to 64-year old vs 18- to 30-year old), male gender (OR 2.72, CI 1.804 to 4.103]), and the presence of CMC (OR 4.55, CI 2.193 to 9.436) for 2 vs none). No differences in mortality were found among NTGH, TGH, and PH. Cardiovascular procedures were more common in PH hospitalizations and were associated with higher costs and LOS. CMCs increase costs and mortality. In-hospital mortality is increased with age, male gender, and the presence of hypoplastic left heart syndrome.
Department of Internal Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Pediatrics, The University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: rtcollins@uams.edu.
Ronnie Thomas
RT
Collins
Department of Pediatrics, The University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Pratik
P
Doshi
Department of Pediatrics, The University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Jennifer
J
Onukwube
Department of Internal Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Ricki Y
RY
Fram
Department of Pediatrics, The University of Arkansas for Medical Sciences, Little Rock, Arkansas.
James M
JM
Robbins
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006330:Heart Defects, Congenital / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006769:Hospitals, General; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000191:economics / Q000453:epidemiology / Q000401:mortality*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D018785:Tricuspid Atresia / Q000191:economics / Q000453:epidemiology / Q000401:mortality*; D055815:Young Adult