title: Mortality, rehospitalizations and costs in children undergoing a cardiac procedure in their first year of life in New South Wales, Australia.
abstract: BACKGROUND
  Cardiac procedures are part of management for many children with congenital heart disease (CHD). Using population health data, this study explores health outcomes of children undergoing a cardiac procedure in the first year of life to better understand the impact of CHD on children, families and health services.
  
  
  RESULTS
  A population-based record-linkage cohort study was undertaken. Rate of cardiac procedures in the first year of life over the study period 2001-2012 in New South Wales, Australia, was steady at 2.5 children per 1000 live births, accounting for 2722 children. Excluding those with isolated closure of patent ductus arteriosus (n=416), 50% required readmission in the first year of life. Over 1/5th had an additional non-cardiac congenital anomaly. Average total cost per infant for initial procedure admission was $67,054 AUD ($63,124-$70,984) with a median length of stay (LOS) 13days (IQR 8-23). Average cost per readmission in the first year of life was $11,342 (95% CI 10,361-$12,323) with median LOS 2days (IQR 1-5). Mortality rate in the 30days following initial procedure was 3.1% (72/2306). Mortality rate by age 1year was 7.1%, and 13.8% for those who had neonatal surgery.
  
  
  CONCLUSIONS
  Risk of mortality in operatively-managed CHD extends beyond the immediate perioperative period. Children undergoing a cardiac procedure in their first year are often readmitted to hospital for both further planned procedures and unplanned reasons such as infection. These readmissions capture the significant impact of illness and pose substantial financial cost to the health system.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia; North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia. Electronic address: claire.lawley@health.nsw.gov.au.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Lawley
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Lain
authors.affiliation: Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia; North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
authors.forename: Gemma A
authors.initials: GA
authors.lastname: Figtree
authors.affiliation: Heart Centre for Children, Children's Hospital at Westmead & Sydney Children's Hospital Cardiac Service, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Sholler
authors.affiliation: Heart Centre for Children, Children's Hospital at Westmead & Sydney Children's Hospital Cardiac Service, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: David S
authors.initials: DS
authors.lastname: Winlaw
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
mesh_terms: D000328:Adult; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000401:mortality / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D017721:Hospital Costs / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009026:Mortality / Q000639:trends; D009517:New South Wales / Q000453:epidemiology; D010359:Patient Readmission / Q000191:economics* / Q000639:trends*; D055815:Young Adult
keywords: Cardiac catheterization; Cardiac surgery; Congenital heart disease; Health services research; Pediatrics