Outcome and Resource Utilization of Infants Born With Hypoplastic Left Heart Syndrome in the Intermountain West

The objective of the present study was to characterize the outcomes and resource utilization of all infants born with hypoplastic left heart syndrome (HLHS) in the Intermountain West. This was a retrospective cohort study of all infants born with HLHS in the Intermountain West from January 1995 and...

Full description

Saved in:

Bibliographic Details
Published in:	The American journal of cardiology Vol. 110; no. 5; pp. 720 - 727
Main Authors:	Menon, Shaji C., MD, Keenan, Heather T., MD, Weng, Hsin-Yi Cindy, MS, Lambert, Linda M., MSN-FNP, Burch, Philip T., MD, Edwards, Reggi, Spackman, Alison, Korgenski, Kent E., MT, Tani, Lloyd Y., MD
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-09-2012 Elsevier Elsevier Limited
Subjects:	Biological and medical sciences Birth defects Cardiac Surgical Procedures - economics Cardiac Surgical Procedures - methods Cardiology. Vascular system Cardiovascular Cohort Studies Colleges & universities Confidence intervals Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Cost of Illness Cost-Benefit Analysis Female Graft Survival Health Care Costs Health Resources - utilization Heart Heart surgery Heart Transplantation - economics Heart Transplantation - methods Heart Transplantation - mortality Hospitalization Hospitalization - economics Hospitalization - statistics & numerical data Hospitals Humans Hypoplastic Left Heart Syndrome - diagnostic imaging Hypoplastic Left Heart Syndrome - mortality Hypoplastic Left Heart Syndrome - surgery Infant, Newborn Intervention Male Medical sciences Multivariate analysis Nevada Ostomy Palliative Care - economics Palliative Care - methods Patient Readmission - economics Patient Readmission - statistics & numerical data Postoperative Complications - mortality Pulmonary arteries Regression analysis Reporting requirements Retrospective Studies Statistical analysis Surgical outcomes Survival analysis Survival Rate Transplants & implants Ultrasonography Utah Variables Utah Human Prognosis Heart disease West Resource Cardiovascular disease Left Heart Hypoplasia Infant Circulatory system Cardiology Congenital disease Syndrome
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	The objective of the present study was to characterize the outcomes and resource utilization of all infants born with hypoplastic left heart syndrome (HLHS) in the Intermountain West. This was a retrospective cohort study of all infants born with HLHS in the Intermountain West from January 1995 and January 2010. The cohort was divided into 3 eras: era 1, 1995 to 1999; era 2, 2000 to 2004; and era 3, 2005 to 2010. Cox proportional hazards regression analysis was performed to assess mortality. The lifetime hospitalization days and charges were also determined. Of the 245 infants identified, 65% were male infants and 172 (70%) underwent Stage 1 palliation. The transplant-free survival rate for the entire cohort was 33% at 14 years. The 1-year transplant-free survival rate for the surgical cohort was 60% in era 3. The infants whose initial presentation included shock, restrictive or intact atrial septum, chromosomal defects, or multiorgan dysfunction had an increased risk of death. A recent era of birth, greater birthweight, and older gestational age were associated with improved survival. The factors associated with mortality after stage 1 included surgical procedure type (Blalock-Taussig vs Sano shunt, hazard ratio 2.1), requirement for postoperative extracorporeal membrane oxygenation (hazard ratio 4.2), postoperative renal dysfunction (hazard ratio 3.0), anomalous pulmonary venous return (hazard ratio 2.9), and moderate or greater tricuspid valve regurgitation at any point (hazard ratio 2.0). For patients who had undergone stage 1, 2, or 3 palliation, the median cumulative lifetime hospitalization was 32, 48, and 65 days, and the median cumulative lifetime charges for hospitalization were $201,812, $253,183, and $296,213, respectively. In conclusion, although hospital-based studies of HLHS have shown significantly improved survival after surgical palliation, population-based studies have shown that HLHS continues to have a high mortality and high resource utilization.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9149 1879-1913
DOI:	10.1016/j.amjcard.2012.04.050