title: Short-Term Costs and Hospitalization Rates in Patients With Adult Congenital Heart Disease After Pulmonic Valve Replacement.
abstract: In the adult congenital heart disease (ACHD) population, pulmonary valve replacement (PVR) is a common intervention, its benefit, however, has been incompletely investigated. This study investigates short- and intermediate-term outcomes after PVR in ACHD. Using State Inpatient Databases from the Healthcare Cost and Utilization Project, we investigated both hospitalization rate and financial burden accrued over the 12-month period after PVR compared with the 12 months before. Among 202 patients who underwent PVR, per patient-year hospitalization rates doubled in the year after PVR compared with the year before (0.16 vs 0.36, p = 0.006). With the exception of postprocedural complications, the most common reasons for hospitalization were unchanged after surgery: 22% of patients were admitted with equal or greater frequency after PVR. These patients experienced higher inpatient costs both at index admission and in the year after PVR (p = 0.004 and p <0.001, respectively). Univariate predictors of increased hospitalizations after PVR were age ≥50 years (p = 0.016), transposition of the great arteries, or conotruncal abnormalities (p <0.001), lipid disorders (p = 0.025), hypertension (p = 0.033), and number of chronic conditions ≥4 (p = 0.004). Multivariate analysis identified transposition of the great arteries or conotruncal abnormalities as an independent risk factor for increased hospitalization and cost post-PVR (p ≤0.001). In conclusion, short-term costs and hospitalization rates increase after PVR in a small group of patients with ACHD.
authors.affiliation: Cardiology Department, Barnes-Jewish Hospital, Washington University, Saint Louis, Missouri.
authors.forename: Deana
authors.initials: D
authors.lastname: Mikhalkova
authors.affiliation: Cardiology Department, Washington University, Saint Louis, Missouri.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.affiliation: Cardiology Department, Baylor Heart and Vascular Hospital, Dallas, Texas. Electronic address: acedars97@gmail.com.
authors.forename: Ari
authors.initials: A
authors.lastname: Cedars
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006330:Heart Defects, Congenital / Q000150:complications / Q000191:economics / Q000601:surgery*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States