Admission to dedicated pediatric cardiac intensive care units is associated with decreased resource use in neonatal cardiac surgery.
J Thorac Cardiovasc Surg
; 155(6): 2606-2614.e5, 2018 06.
Article
em En
| MEDLINE
| ID: mdl-29550071
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.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Terapia Intensiva Neonatal
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Custos Hospitalares
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Procedimentos Cirúrgicos Cardíacos
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Hospitalização
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article