Does value vary by center surgical volume for neonates with truncus arteriosus? A multicenter study.

BACKGROUND: Truncus arteriosus is a congenital heart defect with high resource utilization, cost and mortality. Value assessment (outcome/cost) can improve quality of care and decrease cost. We hypothesize that truncus arteriosus repair at a high-volume center results in better outcomes at lower cost (higher value) compared with a low-volume center.

METHODS: We retrospectively analyzed a multicenter cohort of neonates undergoing truncus arteriosus repair (2004-2015) using the Pediatric Health Information Systems database. Multivariate quantile, logistic and negative binomial regression models were used to evaluate total hospital cost, in-hospital mortality, ventilation days, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days of inotrope use by center volume (high volume >3/year) and age at repair adjusting for gender, ethnicity, race, genetic abnormality, prematurity, low birth weight, concurrent interrupted arch repair and truncal valve repair.

RESULTS: Of 1,024 neonates with truncus arteriosus, 495 (48%) were at high-volume centers. Costs at the 75th percentile were lower at high vs. low-volume centers by $28,456 (p=0.02) at all ages at repair. Patients at high-volume centers had lower median post-op ventilation days 5 vs. 6d (p<0.001), ICU LOS 13 vs. 19d (p<0.001), hospital LOS 23 vs. 28d (p=0.02), and inotrope use 3 vs. 4d (p=0.004). In-hospital mortality did not differ by center volume.

CONCLUSIONS: In neonates undergoing truncus arteriosus repair, costs are lower, and outcomes are better resulting in higher value at all ages of repair at high volume centers. Value-based interventions should be considered to improve outcomes and decrease cost in truncus arteriosus care.