Pediatric Cardiology

, Volume 38, Issue 5, pp 1065–1070 | Cite as

Resource Utilization Associated with Extracardiac Co-morbid Conditions Following Congenital Heart Surgery in Infancy

  • Krista E. Tuomela
  • John B. Gordon
  • Laura D. Cassidy
  • Sarah Johaningsmeir
  • Nancy S. Ghanayem
Original Article


Congenital heart disease (CHD) is often associated with chronic extracardiac co-morbid conditions (ECC). The presence of ECC has been associated with greater resource utilization during the operative period; however, the impact beyond hospital discharge has not been described. This study sought to understand the scope of chronic ECC in infants with CHD as well as to describe the impact of ECC on resource utilization after discharge from the index cardiac procedure. IRB approved this retrospective study of infants <1 year who had cardiac surgery from 2006 and 2011. Demographics, diagnoses, procedures, STAT score, and ECC were extracted from the medical record. Administrative data provided frequency of clinic and emergency room visits, admissions, cumulative hospital days, and hospital charges for 2 years after discharge from the index procedure. Data were compared using Mann–Whitney Rank Sum Test with p < 0.05 considered significant. ECC occurred in 55% (481/876) of infants. Median STAT score was higher in the group with ECC (3 vs. 2, p < 0.001). Resource utilization after discharge from the index procedure as defined by median hospital charges (78 vs. 10 K, p < 0.001 and unplanned hospital days 4 vs. 0, p < 0.001) was higher in those with ECC, and increased with the greater number of ECC, even after accounting for surgical complexity. STAT score and the presence of multiple ECC were associated with higher resource utilization following the index cardiac surgical procedure. These data may be helpful in deciding which children might benefit from a cardiac complex care program that partners families and providers to improve health and decrease healthcare costs.


Children with medical complexity Congenital heart disease Multiple chronic complex conditions 



This research was supported by funding from the Jack Hartmann Open and Medical Student Summer Research Program at the Medical College of Wisconsin. The authors would like to thank Patricia Stachowiak and Maryanne Kessel from Children’s Hospital of Wisconsin, Milwaukee, WI for their assistance in obtaining administrative data.

Compliance with Ethical Standards

Conflicts of interest

The author(s) declare that they have no competing interests.


  1. 1.
    Simeone RM, Oster ME, Hobbs CA, Robbins JM, Collins RT, Honein MA (2015) Population-based study of hospital costs for hospitalizations of infants, children, and adults with a congenital heart defect, arkansas 2006 to 2011. Birth Defects Res A 103(9):814–820CrossRefGoogle Scholar
  2. 2.
    Connor JA, Gauvreau K, Jenkins KJ (2005) Factors associated with increased resource utilization for congenital heart disease. Pediatrics 116(3):689–695. doi: 10.1542/peds.2004-2071 CrossRefPubMedGoogle Scholar
  3. 3.
    Ungerleider MDRM, Bengur MDAR, Kessenich BSNAL et al (1997) Risk factors for higher cost in congenital heart operations. Ann Thorac Surg 64(1):44–49CrossRefPubMedGoogle Scholar
  4. 4.
    Raucci FJ Jr, Hoke TR, Gutgesell HP (2014) Predicting economic and medical outcomes based on risk adjustment for congenital heart surgery classification of pediatric cardiovascular surgical admissions. Am J Cardiol 114(11):1740–1744CrossRefPubMedGoogle Scholar
  5. 5.
    Dean PN, Hillman DG, McHugh KE, Gutgesell HP (2011) Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome. Pediatrics 128(5):e1181–e1186. doi: 10.1542/peds.2010-3742 CrossRefPubMedGoogle Scholar
  6. 6.
    Billett J, Cowie MR, Gatzoulis MA, Vonder Muhll IF, Majeed A (2008) Comorbidity, healthcare utilisation and process of care measures in patients with congenital heart disease in the UK: Cross-sectional, population-based study with case-control analysis. Heart 94(9):1194–1199CrossRefPubMedGoogle Scholar
  7. 7.
    Newacheck PW, Stoddard JJ (1994) Prevalence and impact of multiple childhood chronic illnesses. J Pediatr 124(1):40–48CrossRefPubMedGoogle Scholar
  8. 8.
    Massin MM, Astadicko I, Dessy H (2007) Noncardiac comorbidities of congenital heart disease in children. Acta Paediatr 96(5):753–755CrossRefPubMedGoogle Scholar
  9. 9.
    O’Brien SM, Clarke DR, Jacobs JP et al (2009) An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 138(5):1139–1153CrossRefPubMedGoogle Scholar
  10. 10.
    Gordon JB, Colby HH, Bartelt T, Jablonski D, Krauthoefer ML, Havens P (2007) A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs. Arch Pediatr Adolesc Med 161(10):937–944CrossRefPubMedGoogle Scholar
  11. 11.
    Greenwood R, Rosenthal A, Parisi L, Fyler D, Nadas A (1975) Extracardiac abnormalities in infants with congenital heart disease. Pediatrics 55(4):485PubMedGoogle Scholar
  12. 12.
    Fernandes SM, Sanders LM (2015) Patient-centered medical home for patients with complex congenital heart disease.[miscellaneous article]. Curr Opin Pediatr 27(5):581–586Google Scholar
  13. 13.
    McPherson M, Arango P, Fox H et al (1998) A new definition of children with special health care needs. Pediatrics 102(1):137–140CrossRefPubMedGoogle Scholar
  14. 14.
    Kogan MD, Strickland BB, Newacheck PW (2009) Building systems of care: Findings from the national survey of children with special health care needs. Pediatrics 124(SUPPL. 4):S333–S336CrossRefPubMedGoogle Scholar
  15. 15.
    Cohen E, Berry JG, Camacho X, Anderson G, Wodchis W, Guttmann A (2012) Patterns and costs of health care use of children with medical complexity. Pediatrics 130(6):e1463–e1470. doi: 10.1542/peds.2012-0175 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kuo D, Melguizo-Castro M, Goudie A, Nick T, Robbins J, Casey P (2015) Variation in child health care utilization by medical complexity. Maternal Child Health 19(1):40–48Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Krista E. Tuomela
    • 4
  • John B. Gordon
    • 1
    • 4
  • Laura D. Cassidy
    • 3
    • 4
  • Sarah Johaningsmeir
    • 1
    • 4
  • Nancy S. Ghanayem
    • 2
    • 4
    • 5
  1. 1.Divisions of Special Needs, Department of PediatricsPediatric Division of Special NeedsMilwaukeeUSA
  2. 2.Critical Care, Department of PediatricsPediatric Division of Special NeedsMilwaukeeUSA
  3. 3.Institute for Health and SocietyMilwaukeeUSA
  4. 4.Medical College of WisconsinMilwaukeeUSA
  5. 5.Department of Pediatrics, Division of Critical CareBaylor College of Medicine and Texas Children’s HospitalHoustonUSA

Personalised recommendations