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

• 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
• DOI: 10.1016/j.amjcard.2012.04.050
• EISSN: 1879-1913
• ISSN: 0002-9149

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.