Abstract 16858: Factors Associated With Length of Stay and Cost of the Fontan Surgery: A Multi-Institutional Study

Abstract

Introduction: We sought to determine factors associated with length of stay (LOS) and cost of the Fontan surgery in a contemporary large multi-institutional cohort. Hypothesis: Independent and modifiable risk factors associated with longer LOS and higher cost will be identified. Methods: We performed a retrospective cohort study of Fontan surgey (1/2004 - 7/2013) using the Pediatric Health Information Systems (PHIS) database (40 US children’s hospitals). Outcome parameters were LOS and costs at Fontan surgery. Predictor variables were demographics (race, insurance, region, rural vs city, commute time, surgical volume), cardiac and other diagnoses, Glenn events, readmission between Glenn and Fontan, and age at Glenn and Fontan. Following a stepwise selection procedure, significant predictors of LOS and cost were included in a generalized linear model with the appropriate inverse Gaussian distribution and the log link function with LOS and cost (adjusted to 2012 $ and region) as the dependent variable. Results: For the 2187 patients (62% male) who had Fontan surgery, the median age at surgery was 1146 days (IQR: 943-1369) and at Glenn was 165 days (IQR: 133-208). Following Fontan, the median ICU LOS was 3 days (IQR: 2-6) and total LOS was 9 days (IQR: 7-14). The median total hospital cost was $93, 900 (IQR: 67,800-136,100). Post-operative mortality was 1% (N=21). Region, insurance, race, surgical volume were the predominant factors associated with both cost and LOS (Table 1). Conclusion: This is the largest multicenter contemporary study describing the factors (particularly healthcare delivery factors) associated with resource utilization during the Fontan hospitalization. Health care delivery variables dominated the factors predicting increased resource utilization. Changes in health care policy should target health care delivery risk factors (race, region, insurance, driving distance, surgical volume) to reduce cost in this resource intensive population.