Resource utilization in children with paracorporeal continuous-flow ventricular assist devices.

Autor:	Burstein DS; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: bursteind@email.chop.edu., Griffis H; Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Zhang X; Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Cantor RS; Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama., Dai D; Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Shamszad P; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Huang YS; Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Morales DLS; Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Hall M; Children's Hospital Association, Lenexa, Kansas., Lin KY; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., O'Connor MJ; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Zinn M; Division of Cardiology, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Edens RE; Department of Pediatrics, Children's Minnesota, Minneapolis, Minnesota., Parrino PE; Division of Cardiothoracic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana., Kirklin JK; Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama., Rossano JW; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2021 Jun; Vol. 40 (6), pp. 478-487. Date of Electronic Publication: 2021 Feb 22.
DOI:	10.1016/j.healun.2021.02.011
Abstrakt:	Background: Paracorporeal continuous-flow ventricular assist devices (PCF VAD) are increasingly used in pediatrics, yet PCF VAD resource utilization has not been reported to date. Methods: Pediatric Interagency Registry for Mechanically Assisted Circulatory Support (PediMACS), a national registry of VADs in children, and Pediatric Health Information System (PHIS), an administrative database of children's hospitals, were merged to assess VAD implants from 19 centers between 2012 and 2016. Resource utilization, including hospital and intensive care unit length of stay (LOS), and costs are analyzed for PCF VAD, durable VAD (DVAD), and combined PCF-DVAD support. Results: Of 177 children (20% PCF VAD, 14% PCF-DVAD, 66% DVAD), those with PCF VAD or PCF-DVAD are younger (median age 4 [IQR 0-10] years and 3 [IQR 0-9] years, respectively) and more often have congenital heart disease (44%; 28%, respectively) compared to DVAD (11 [IQR 3-17] years; 14% CHD); p < 0.01 for both. Median post-VAD LOS is prolonged ranging from 43 (IQR 15-82) days in PCF VAD to 72 (IQR 55-107) days in PCF-DVAD, with significant hospitalization costs (PCF VAD $450,000 [IQR $210,000-$780,000]; PCF-DVAD $770,000 [IQR $510,000-$1,000,000]). After adjusting for patient-level factors, greater post-VAD hospital costs are associated with LOS, ECMO pre-VAD, greater chronic complex conditions, and major adverse events (p < 0.05 for all). VAD strategy and underlying cardiac disease are not associated with LOS or overall costs, although PCF VAD is associated with higher daily-level costs driven by increased pharmacy, laboratory, imaging, and clinical services costs. Conclusion: Pediatric PCF VAD resource utilization is staggeringly high with costs primarily driven by pre-implantation patient illness, hospital LOS, and clinical care costs. Competing Interests: Conflict of interest disclosure The PediMACS database is funded by a contract grant (HHSN268201100025C) from the National Heart, Lung, and Blood Institute. JWR has served as a consultant for Novartis, Abiomed, Bayer, Amgen. DLSM has served as a consultant for Abbott, Syncardia, and Berlin Heart. The other authors have no relevant disclosures to report. (Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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