Admission to dedicated pediatric cardiac intensive care units is associated with decreased resource use in neonatal cardiac surgery

Joyce T. Johnson*, Jacob F. Wilkes, Shaji C. Menon, Lloyd Y. Tani, Hsin yi Weng, Bradley S. Marino, Nelangi M. Pinto

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality. Methods: We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004 and 2013 by using the Pediatric Health Information Systems database (44 children's hospitals). Multivariate generalized estimating equations adjusted for center- and patient-specific risk factors and stratified by age at admission were performed to examine the association of admission intensive care unit (ICU) with total hospital costs, mortality, and length of stay. Results: Of 19,984 neonates (60% male) identified, 39% were initially admitted to a cardiac ICU (CICU), 48% to a neonatal ICU (NICU), and 13% to a pediatric ICU. In adjusted models, admission to a CICU versus NICU was associated with a $20,440 reduction in total hospital cost for infants aged 2 to 7 days at admission (P =.007) and a $23,700 reduction in total cost for infants aged 8 to 14 days at admission (P =.01). Initial admission to a CICU or pediatric ICU versus NICU at <15 days of age was associated with shorter hospital and ICU length of stay and fewer days of mechanical ventilation. There was no difference in adjusted mortality by admission location. Conclusions: Admission to an ICU specializing in cardiac care is associated with significantly decreased hospital costs and more efficient resource use for neonates requiring cardiac surgery.

Original languageEnglish (US)
Pages (from-to)2606-2614.e5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Pediatric Intensive Care Units
Thoracic Surgery
Intensive Care Units
Hospital Costs
Neonatal Intensive Care Units
Newborn Infant
Length of Stay
Health Information Systems
Mortality
Critical Care
Hospital Mortality
Artificial Respiration
Health Care Costs
Databases
Pediatrics
Costs and Cost Analysis

Keywords

  • intensive care unit
  • neonatal congenital heart disease
  • resource use
  • surgical repair

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{2f73312ce7be45f189148e95afe5cc85,
title = "Admission to dedicated pediatric cardiac intensive care units is associated with decreased resource use in neonatal cardiac surgery",
abstract = "Objective: Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality. Methods: We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004 and 2013 by using the Pediatric Health Information Systems database (44 children's hospitals). Multivariate generalized estimating equations adjusted for center- and patient-specific risk factors and stratified by age at admission were performed to examine the association of admission intensive care unit (ICU) with total hospital costs, mortality, and length of stay. Results: Of 19,984 neonates (60{\%} male) identified, 39{\%} were initially admitted to a cardiac ICU (CICU), 48{\%} to a neonatal ICU (NICU), and 13{\%} to a pediatric ICU. In adjusted models, admission to a CICU versus NICU was associated with a $20,440 reduction in total hospital cost for infants aged 2 to 7 days at admission (P =.007) and a $23,700 reduction in total cost for infants aged 8 to 14 days at admission (P =.01). Initial admission to a CICU or pediatric ICU versus NICU at <15 days of age was associated with shorter hospital and ICU length of stay and fewer days of mechanical ventilation. There was no difference in adjusted mortality by admission location. Conclusions: Admission to an ICU specializing in cardiac care is associated with significantly decreased hospital costs and more efficient resource use for neonates requiring cardiac surgery.",
keywords = "intensive care unit, neonatal congenital heart disease, resource use, surgical repair",
author = "Johnson, {Joyce T.} and Wilkes, {Jacob F.} and Menon, {Shaji C.} and Tani, {Lloyd Y.} and Weng, {Hsin yi} and Marino, {Bradley S.} and Pinto, {Nelangi M.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.jtcvs.2018.01.100",
language = "English (US)",
volume = "155",
pages = "2606--2614.e5",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

Admission to dedicated pediatric cardiac intensive care units is associated with decreased resource use in neonatal cardiac surgery. / Johnson, Joyce T.; Wilkes, Jacob F.; Menon, Shaji C.; Tani, Lloyd Y.; Weng, Hsin yi; Marino, Bradley S.; Pinto, Nelangi M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 155, No. 6, 01.06.2018, p. 2606-2614.e5.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Admission to dedicated pediatric cardiac intensive care units is associated with decreased resource use in neonatal cardiac surgery

AU - Johnson, Joyce T.

AU - Wilkes, Jacob F.

AU - Menon, Shaji C.

AU - Tani, Lloyd Y.

AU - Weng, Hsin yi

AU - Marino, Bradley S.

AU - Pinto, Nelangi M.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Objective: Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality. Methods: We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004 and 2013 by using the Pediatric Health Information Systems database (44 children's hospitals). Multivariate generalized estimating equations adjusted for center- and patient-specific risk factors and stratified by age at admission were performed to examine the association of admission intensive care unit (ICU) with total hospital costs, mortality, and length of stay. Results: Of 19,984 neonates (60% male) identified, 39% were initially admitted to a cardiac ICU (CICU), 48% to a neonatal ICU (NICU), and 13% to a pediatric ICU. In adjusted models, admission to a CICU versus NICU was associated with a $20,440 reduction in total hospital cost for infants aged 2 to 7 days at admission (P =.007) and a $23,700 reduction in total cost for infants aged 8 to 14 days at admission (P =.01). Initial admission to a CICU or pediatric ICU versus NICU at <15 days of age was associated with shorter hospital and ICU length of stay and fewer days of mechanical ventilation. There was no difference in adjusted mortality by admission location. Conclusions: Admission to an ICU specializing in cardiac care is associated with significantly decreased hospital costs and more efficient resource use for neonates requiring cardiac surgery.

AB - Objective: Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality. Methods: We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004 and 2013 by using the Pediatric Health Information Systems database (44 children's hospitals). Multivariate generalized estimating equations adjusted for center- and patient-specific risk factors and stratified by age at admission were performed to examine the association of admission intensive care unit (ICU) with total hospital costs, mortality, and length of stay. Results: Of 19,984 neonates (60% male) identified, 39% were initially admitted to a cardiac ICU (CICU), 48% to a neonatal ICU (NICU), and 13% to a pediatric ICU. In adjusted models, admission to a CICU versus NICU was associated with a $20,440 reduction in total hospital cost for infants aged 2 to 7 days at admission (P =.007) and a $23,700 reduction in total cost for infants aged 8 to 14 days at admission (P =.01). Initial admission to a CICU or pediatric ICU versus NICU at <15 days of age was associated with shorter hospital and ICU length of stay and fewer days of mechanical ventilation. There was no difference in adjusted mortality by admission location. Conclusions: Admission to an ICU specializing in cardiac care is associated with significantly decreased hospital costs and more efficient resource use for neonates requiring cardiac surgery.

KW - intensive care unit

KW - neonatal congenital heart disease

KW - resource use

KW - surgical repair

UR - http://www.scopus.com/inward/record.url?scp=85043510900&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043510900&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2018.01.100

DO - 10.1016/j.jtcvs.2018.01.100

M3 - Article

C2 - 29550071

AN - SCOPUS:85043510900

VL - 155

SP - 2606-2614.e5

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -