Pediatric Cardiology

, Volume 40, Issue 1, pp 138–146 | Cite as

Cost Savings Analysis of Early Extubation Following Congenital Heart Surgery

  • S. Holowachuk
  • W. Zhang
  • S. K. Gandhi
  • A. H. Anis
  • J. E. Potts
  • K. C. HarrisEmail author
Original Article


The clinical benefit of early extubation following congenital heart surgery has been demonstrated; however, its effect on resource utilization has not been rigorously evaluated. We sought to determine the cost savings of implementing an early extubation pathway for children undergoing surgery for congenital heart disease. We performed a cost savings analysis after implementation of an early extubation strategy among children undergoing congenital heart surgery at British Columbia Children’s Hospital (BCCH) over a 2.5-year period. All patients undergoing one of the eight Society of Thoracic Surgeons (STS) benchmark operations, ASD repair, or bidirectional cavopulmonary anastomosis were included in the analysis (n = 370). We compared our data to aggregate STS multi-institutional data from a contemporary cohort. We estimated daily costs for ICU care, ward care, medications, imaging, additional procedures, and allied health care using an administrative database. Direct costs, indirect costs, and cost savings were estimated. Simulation methods, Monte Carlo, and bootstrapping were used to calculate the 95% credible intervals for all estimates. The mean cost savings per procedure was $12,976 and the total estimated cost savings over the study period at BCCH was $4.8 million with direct costs accounting for 91% of cost savings. Sensitivity analysis demonstrated a mean cost savings range of $11,934–$14,059 per procedure. Early extubation is associated with substantial cost savings due to reduced hospital resource utilization. Implementation of an early extubation strategy following congenital heart surgery may contribute to improved resource utilization.


Cost savings Congenital heart disease Early extubation 


Compliance with Ethical Standards

Conflict of interests

The authors declared that they have no conflict of interests.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

246_2018_1970_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 KB)


  1. 1.
    Jacobs JP, Jacobs ML, Mavroudis C, Backer CL, Lacour-Gayet FG, Tchervenkov CI et al (2008) Nomenclature and databases for the surgical treatment of congenital cardiac disease—an updated primer and an analysis of opportunities for improvement. Cardiol Young 18(S2):38CrossRefGoogle Scholar
  2. 2.
    Shanmugam G, Clark LL, Burton HJ, Warren AE, O’Blenes SB, Hancock Friesen CL (2012) Improving and standardizing capture of pediatric cardiac surgical complications. J Thorac Cardiovasc Surg 144(3):570–576CrossRefGoogle Scholar
  3. 3.
    Preisman S, Lembersky H, Yusim Y, Raviv-Zilka L, Perel A, Keidan I et al (2009) A randomized trial of outcomes of anesthetic management directed to very early extubation after cardiac surgery in children. J Cardiothorac Vasc Anesth 23(3):348–357CrossRefGoogle Scholar
  4. 4.
    Lawrence EJ, Nguyen K, Morris SA, Hollinger I, Graham DA, Jenkins KJ et al (2013) Economic and safety implications of introducing fast tracking in congenital heart surgery. Circ Cardiovasc Qual Outcomes 6(2):201–207CrossRefGoogle Scholar
  5. 5.
    Howard F, Brown KL, Garside V, Walker I, Elliott MJ (2010) Fast-track paediatric cardiac surgery: the feasibility and benefits of a protocol for uncomplicated cases. Eur J Cardiothorac Surg 37(1):193–196CrossRefGoogle Scholar
  6. 6.
    Harris KC, Holowachuk S, Pitfield S, Sanatani S, Froese N, Potts JE et al (2014) Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg 148(6):2642–2648CrossRefGoogle Scholar
  7. 7.
    Alghamdi AA, Singh SK, Hamilton BCS, Yadava M, Holtby H, Van Arsdell GS et al (2010) Early extubation after pediatric cardiac surgery: systematic review, meta-analysis, and evidence-based recommendations. J Card Surg 25(5):586–595CrossRefGoogle Scholar
  8. 8.
    Jacobs JP, Jacobs ML, Austin EH, Mavroudis C, Pasquali SK, Lacour-Gayet FG et al (2012) Quality measures for congenital and pediatric cardiac surgery. World J Pediatr Congenit Heart Surg 3(1):32–47CrossRefGoogle Scholar
  9. 9.
    Jacobs JP, O’Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI et al (2011) Variation in outcomes for benchmark operations: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 92(6):2184–2192CrossRefGoogle Scholar
  10. 10.
    Pasquali SK, Jacobs ML, He X, Shah SS, Peterson ED, Hall M et al (2014) Variation in congenital heart surgery costs across hospitals. Ped 133(3):e553–e560CrossRefGoogle Scholar
  11. 11.
    Earnings, average hourly for hourly paid employees, by province and territory. Statistics Canada. Accessed Aug 2014
  12. 12.
    Lions Society. Easter seal house. Accessed Aug 2014
  13. 13.
    Travel directive, appendix b: kilometric rates, effective January 1 (2013) Treasury board of Canada. Accessed Aug 2014
  14. 14.
    Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL (2005) Methods for the economic evaluation of health care programme, 3rd edn. Oxford University Press, OxfordGoogle Scholar
  15. 15.
  16. 16.
    Connor JA (2005) Factors associated with increased resource utilization for congenital heart disease. Pediatrics 116(3):689–695CrossRefGoogle Scholar
  17. 17.
    Chan T, Kim J, Minich LL, Pinto NM, Waitzman NJ (2015) Surgical volume, hospital quality, and hospitalization cost in congenital heart surgery in the United States. Pediatr Cardiol 36(1):205–213CrossRefGoogle Scholar
  18. 18.
    Pasquali SK, Sun J-L, d’ Almada P, Jaquiss RDB, Lodge AJ, Miller N et al (2011) Center variation in hospital costs for patients undergoing congenital heart surgery. Circ Cardiovasc Qual Outcomes 4(3):306–312CrossRefGoogle Scholar
  19. 19.
    Benavidez OJ, Connor JA, Gauvreau K, Jenkins KJ (2007) The contribution of complications to high resource utilization during congenital heart surgery admissions. Congenit Heart Dis 2(5):319–326CrossRefGoogle Scholar
  20. 20.
    Ing RJ, Twite MD (2015) The year in review anesthesia for congenital heart disease 2014. Seminars in cardiothoracic and vascular anesthesia [Internet]. SAGE; p 12–20. Accessed 5 Jun 2015

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • S. Holowachuk
    • 1
  • W. Zhang
    • 2
    • 3
  • S. K. Gandhi
    • 1
  • A. H. Anis
    • 2
    • 3
  • J. E. Potts
    • 1
  • K. C. Harris
    • 1
    Email author
  1. 1.Children’s Heart CentreBC Children’s HospitalVancouverCanada
  2. 2.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  3. 3.Centre for Health Evaluation and Outcome SciencesSt. Paul’s HospitalVancouverCanada

Personalised recommendations