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Original research
Costs of postoperative morbidity following paediatric cardiac surgery: observational study
  1. Emma Hudson1,
  2. Katherine Brown2,
  3. Christina Pagel3,4,
  4. Jo Wray2,
  5. David Barron5,
  6. Warren Rodrigues6,
  7. Serban Stoica7,
  8. Shane M Tibby8,
  9. Victor Tsang2,
  10. Deborah Ridout9,
  11. Stephen Morris1
  1. 1 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  2. 2 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  3. 3 Clinical Operational Research Unit, University College of London, London, UK
  4. 4 Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
  5. 5 Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  6. 6 Paediatric Intensive care Unit, NHS Greater Glasgow and Clyde Inverclyde Royal Hospital, Glasgow, UK
  7. 7 Department of Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  8. 8 Department of Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
  9. 9 Paediatric Epidemiology Biostatistics, Institute of Child Health, London, UK
  1. Correspondence to Emma Hudson, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 1TN, UK; eh645{at}medschl.cam.ac.uk

Abstract

Objective Early mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery.

Design Two methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively.

Setting Five specialist paediatric cardiac surgery centres, accounting for half of UK patients.

Patients Cohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures.

Methods Risk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service.

Outcome measures Impact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs.

Results Seven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3–£17 289) to £66 784 (£40 609–£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year.

Conclusion Postoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.

  • cardiac surgery
  • costing
  • health economics
  • health service
  • paediatric surgery
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2019-318499

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    Footnotes

    • Twitter @chrischirp

    • Funding This project was funded by the National Institute for Health Research Health Services and Delivery Research programme (Project No 12/5005/06). KB, DR, JW and VT were supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.

    • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HS&DR programme or the Department of Health and Social Care.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study has ethical approval from London City Road Research Ethics Committee (14-LO-1442).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are not publicly available. For data to be made available to a third party, specific ethical and HRA approvals would be required.