A risk-adjusted study of outcome and resource utilization for congenital diaphragmatic hernia

Abstract

Purpose Perinatal care of infants with congenital diaphragmatic hernia (CDH) is nonstandardized and costly. We examined a risk-adjusted cohort of patients with CDH and hypothesized that (1) among CDH survivors, the cost of the birth admission would be proportional to illness severity, and (2) this cost would be significantly higher compared with a matched non-CDH cohort. Methods A retrospective review of costs and outcomes for all patients with CDH admitted to British Columbia Children's Hospital between 1999 and 2003 was performed. Risk grouping of patients with CDH using a validated admission severity score (Score for Neonatal Acute Physiology–version II [SNAP-II]) was conducted, enabling comparison among infants surviving to discharge. Hospital costs were also compared with a contemporaneous, non-CDH cohort matched for birth weight and SNAP-II. Results Thirty-two infants with CDH were included, of who 5 required extracorporeal membrane oxygenation. Twenty-three (72%) infants survived to discharge, with an average length of stay of 46 days. Average cost per survivor to discharge was $54,102 (vs $13,722 for the non-CDH cohort; P < .05). After SNAP-II stratification of survivors into low-, moderate-, and high-risk groups, a significant cost difference was noted between the moderate- and low-risk and high- and low-risk groups, respectively. Conclusions Infants born with CDH require costly care and can be expected to consume disproportionate resources. Admission SNAP-II score correlates with total cost to discharge. Risk stratification and cost comparison of larger CDH populations may allow identification of cost-efficient treatment strategies.