OBJECTIVES

Systemic-to-pulmonary pediatric shunts are typically used in the first stage of palliative therapy to improve blood oxygenation in infants with cyanotic congenital heart defects. The repair is associated with a high economic burden and patients tend to develop severe complications often resulting in high mortality. This analysis estimates the in-hospital mortality, length of stay (LOS) and inpatient costs in newborn patients (≤1 month old) who had shunt procedures with and without complications.

METHODS

The 2016 Kids’ Inpatient Database was used to identify newborn patients who had a shunt procedure, identified with ICD10-PCS codes as primary or secondary. The sample was further refined with ICD10-CM diagnosis codes associated with this disease such as Tetralogy of Fallot, pulmonary artery atresia and Hypoplastic Left Heart Syndrome. The cohort was then separated into successful versus complicated procedures, which were identified by ICD10-CM T82 codes that describe complications of prosthetic devices. We further identified complicated patients that required an ECMO since ECMO results in significant cost burden. Patient and hospital characteristics, in-hospital mortality, LOS and average costs per admission were estimated.

RESULTS

There were 1,267 admissions for shunt procedures in newborn patients in 2016. Of these, 531 cases were identified as successful shunt patients (37.5% female, 72% treated at a hospital >325 beds, 49% Medicaid insurance) and 63 cases were identified as complicated patients (45% female, 66% treated at a hospital >325 beds, 51% Medicaid insurance). In-hospital mortality, LOS and costs per admission were higher for the complicated cohort (in-hospital mortality 7% versus 9%, LOS 42 days versus 65 days, costs $231,536 versus $380,463). For ECMO cases (N=10), in-hospital mortality, LOS and costs were 16%, 112 and $484,926, respectively.

CONCLUSIONS

Newborn patients with shunt procedures have high in-hospital mortality, LOS and costs. Complicated cases result in increased LOS and 64% higher costs per admission.