Atrial septal defects (ASD) are among the most common congenital heart defects. As more ASDs are corrected by interventional catheterization instead of surgery, it is critical to understand the associated clinical and societal costs. The goal of this study was to use a national U.S. database to describe hospital charges and societal costs for surgical and catheter-based (ASD) closure. Retrospective review of hospital discharge data from the Kids’ Inpatient Database from January 2010 to December 2012. The database was queried for admissions for <21 years old with ICD-9 procedure codes for surgical (35.51 or 35.61) or catheter (35.52) ASD closure; those with other cardiac conditions and/or additional cardiac procedures were excluded. Age, length of stay (LOS), and hospital charges and lost parental wages (societal costs) were compared between groups using t test or Mann–Whitney U test, as appropriate. Four hundred and eighty-six surgical and 305 catheter ASD closures were identified. LOS, hospital charges, and total societal costs were higher in surgical ASD compared to catheter ASD admissions (3.6 vs. 1.3 days, p < 0.001, $87,465 vs. $64,109, p < 0.001, and $90,000 vs. $64,966, p < 0.001, respectively). In this review of a large national inpatient database, we found that hospital and societal costs for surgical ASD closure are significantly higher than catheter ASD closure in the United States in the current era. Factors that likely contribute to this include longer LOS and longer post-operative recovery. Using “real-world” data, this study demonstrates a substantial cost advantage for catheter ASD closure compared to surgical.
Surgery Congenital heart disease Closure ASD/PDA/PFO Economics/cost-effectiveness Pediatric intervention
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The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The need for informed consent was waived by the University of Arizona Institutional Review Board.
Baskett RJ, Tancock E, Ross DB (2003) The gold standard for atrial septal defect closure: current surgical results, with an emphasis on morbidity. Pediatr Cardiol 24:444–447CrossRefPubMedGoogle Scholar
Bolz D, Lacina T, Buser P et al (2005) Long-term outcome after surgical closure of atrial septal defect in childhood with extensive assessment including MRI measurement of the ventricles. Pediatr Cardiol 26:614–621CrossRefPubMedGoogle Scholar
Roos-Hesselink JW, Meijboom FJ, Spitaels SE et al (2003) Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21–33 years. Eur Heart J 24:190–197CrossRefPubMedGoogle Scholar
Kutty S, Hazeem AA, Brown K et al (2012) Long-term (5- to 20-year) outcomes after transcatheter or surgical treatment of hemodynamically significant isolated secundum atrial septal defect. Am J Cardiol 109:1348–1352CrossRefPubMedGoogle Scholar
Meijboom F, Hess J, Szatmari A et al (1993) Long-term follow-up (9 to 20 years) after surgical closure of atrial septal defect at a young age. Am J Cardiol 72:1431–1434CrossRefPubMedGoogle Scholar
King TD, Thompson SL, Steiner C et al (1976) Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA 235:2506–2509CrossRefPubMedGoogle Scholar
Berger F, Vogel M, Alexi-Meskishvili V et al (1999) Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg 118:674–678CrossRefPubMedGoogle Scholar
Cowley CG, Lloyd TR, Bove EL et al (2001) Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder. Am J Cardiol 88:589–591CrossRefPubMedGoogle Scholar
Du ZD, Hijazi ZM, Kleinman CS et al (2002) Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 39:1836–1844CrossRefPubMedGoogle Scholar
Formigari R, Di Donato RM, Mazzera E et al (2001) Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies. J Am Coll Cardiol 37:1707–1712CrossRefPubMedGoogle Scholar
Knepp MD, Rocchini AP, Lloyd TR et al (2010) Long-term follow up of secundum atrial septal defect closure with the amplatzer septal occluder. Congenit Heart Dis 5:32–37CrossRefPubMedGoogle Scholar
Thomson JD, Aburawi EH, Watterson KG et al (2002) Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart 87:466–469CrossRefPubMedPubMedCentralGoogle Scholar
Baker SS, O’Laughlin MP, Jollis JG et al (2002) Cost implications of closure of atrial septal defect. Catheter Cardiovasc Interv 55:83–87CrossRefPubMedGoogle Scholar
Hughes ML, Maskell G, Goh TH et al (2002) Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart 88:67–70CrossRefPubMedPubMedCentralGoogle Scholar
Mylotte D, Quenneville SP, Kotowycz MA et al (2014) Long-term cost-effectiveness of transcatheter versus surgical closure of secundum atrial septal defect in adults. Int J Cardiol 172:109–114CrossRefPubMedGoogle Scholar
O’Byrne ML, Gillespie MJ, Shinohara RT et al (2015) Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects. Am Heart J 169(727–35):e2Google Scholar
Ooi YK, Kelleman M, Ehrlich A et al (2016) Transcatheter versus surgical closure of atrial septal defects in children: a value comparison. JACC Cardiovasc Interv 9:79–86CrossRefPubMedGoogle Scholar
Quek SC, Hota S, Tai BC et al (2010) Comparison of clinical outcomes and cost between surgical and transcatheter device closure of atrial septal defects in Singapore children. Ann Acad Med Singapore 39:629–633PubMedGoogle Scholar
HCUP Kids’ Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP) (2012) Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/kidoverview.jsp. Accessed 15 May 2016
Vergales JE, Wanchek T, Novicoff W et al (2013) Cost-analysis of percutaneous pulmonary valve implantation compared to surgical pulmonary valve replacement. Catheter Cardiovasc Interv 82:1147–1153CrossRefPubMedGoogle Scholar
Silberbach M, Shumaker D, Menashe V et al (1993) Predicting hospital charge and length of stay for congenital heart disease surgery. Am J Cardiol 72:958–963CrossRefPubMedGoogle Scholar
Bartakian S, El-Said HG, Printz B et al (2013) Prospective randomized trial of transthoracic echocardiography versus transesophageal echocardiography for assessment and guidance of transcatheter closure of atrial septal defects in children using the Amplatzer septal occluder. JACC Cardiovasc Interv 6:974–980CrossRefPubMedGoogle Scholar
Moore JW, Vincent RN, Beekman RH et al (2014) Procedural results and safety of common interventional procedures in congenital heart disease: initial report from the National Cardiovascular Data Registry. J Am Coll Cardiol 64:2439–2451CrossRefPubMedGoogle Scholar