Hospital Distribution and Patient Travel Patterns for Congenital Cardiac Surgery in the United States

Abstract

Several countries have regionalized congenital heart surgery (CHS). Before considering regionalization in the US, the current landscape must be understood. This investigation characterized the network of US hospitals providing CHS, including hospital locations and patient travel patterns. Patients ≤18 years undergoing CHS were identified in 2012 State Inpatient Databases from 39 states. Cases were stratified by the RACHS-1 method (high-risk defined as RACHS-1 categoris 4 to 6). Hospital and patient locations were identified. Patients were mapped to hospitals where they underwent surgery. A total of 153 hospitals across 36 states performed ≥1 RACHS-1 case (19,064 operations). Of these, 101 hospitals (66%) were located within 25 miles of another hospital. Median annual RACHS-1 case volume was 90 (range, 1 to 797), with 55 hospitals performing ≤50 cases. A total of 111 hospitals (73%) performed ≥1 high-risk case. Of these, 39 (35%) performed ≤10 high-risk cases/year. Overall mortality rate was 3.5% (n= 666), with risk-adjusted mortality being lowest at hospitals in the highest-volume quartile (≥150 cases/year). About 25% of patients (n= 4,012) traveled >100 miles, with most traveling to hospitals within the highest-volume quartile; 53% of patients (n= 8,376) bypassed the nearest CHS hospital. Mortality was not associated with travel distance. We identified more US hospitals performing CHS than has been previously described. Many are small-volume and are in close proximity to one another. Patients are already traveling long distances to hospitals within the highest-volume quartile. These data help define the current landscape of CHS and associated considerations regarding regionalization.