Pediatric Cardiology

, Volume 38, Issue 7, pp 1359–1364 | Cite as

Outcomes and Costs of Cardiac Surgery in Adults with Congenital Heart Disease

  • Viviane G. Nasr
  • David Faraoni
  • Anne Marie Valente
  • James A. DiNardo
Original Article


Advances in pediatric cardiac surgical and medical care have led to increased survival of patients with congenital heart disease (CHD). Consequently, many CHD patients survive long enough to require cardiac surgery as adults. Using the 2013 Nationwide Inpatient Sample (NIS) database, we compared costs and outcomes for adult patients undergoing surgery for treatment of CHD to a reference population of adults undergoing CABG. Patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) procedure codes. We recorded the demographic characteristics, gender, ethnicity, hospital bed size, hospital length of stay, in-hospital mortality, and comorbidities. Patients with ACHD have higher incidences of in-hospital mortality (2.6 vs. 1.8%), and complication rates including neurologic complications (2.6 vs. 0.9%), thromboembolic complications (3.9 vs. 1.4%), arrhythmias (51.6 vs. 29.8%), hepatic failure (4.44 vs. 2.03%), and sepsis (7.24 vs. 4.61%) (all p < 0.001). In addition, cost is higher in patients with CHD (Coefficient = 0.116, 95% CI, 0.105–0.128; p < 0.001), Elixhauser score ≥ 7 (Coefficient = 0.114, 95% CI, 0.108–0.121; p < 0.001), neurologic complications (Coefficient = 0.169, 95% CI, 0.143–0.196; p < 0.001), thrombotic complications (Coefficient = 0.243, 95% CI, 0.222–0.265; p < 0.001), sepsis (Coefficient = 0.198, 95% CI, 0.185–0.211; p < 0.001), acute kidney injury (Coefficient = 0.056, 95% CI, 0.041–0.063; p < 0.001), elective cases (Coefficient = 0.047, 95% CI, 0.041–0.053; p < 0.001), and length of stay > 6 days (Coefficient = 0.703, 95% CI, 0.697–0.710; p < 0.001). This study shows that ACHD patients undergoing cardiac surgery experience higher hospital costs and poorer outcomes than a reference population of adult CABG patients. Recognition and treatment of comorbidities in ACHD patients undergoing cardiac surgery may provide an opportunity to improve perioperative outcomes in this growing patient population.


Cost Adult congenital heart disease Outcomes CABG 



This work was solely supported by the Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest.

Supplementary material

246_2017_1669_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Viviane G. Nasr
    • 1
  • David Faraoni
    • 3
  • Anne Marie Valente
    • 2
  • James A. DiNardo
    • 1
  1. 1.Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Cardiology, Boston Children’s Hospital and Division of Cardiology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of Anesthesia and Pain Medicine, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada

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