Introduction: We describe regional variation in perioperative care among adults with congenital heart disease (ACHD) undergoing cardiac surgery in the United States. Methods: Analysis using the 2016-2020 Nationwide Inpatient Sample, including admissions of ≥18 years old patients with congenital heart ICD-10 diagnosis codes and cardiac surgical procedure codes. Outcomes included hospitalization costs, length of stay, high-resource utilization (HRU), and in-hospital mortality. Adjusted multilevel regressions estimated observed-to-expected (O/E) ratios and risk-standardized (RS) outcomes. Results: Among 83, 800 admissions, the median age was 59 years (IQR 48-67) and the most common diagnosis was congenital aortic insufficiency (AI) with 58. 7% (n=49, 149). Elective admissions represented 76. 5% (n=64, 115) admissions; valve replacements were coded in 68. 1% (n=57, 065) admissions, followed by CABG (22. 0%, n=18, 420). Regional distribution was 21% West, 20% Northeast, 27% Midwest, and 31% South. Midwest had a higher proportion of valve repairs whereas Northeast had a higher valve replacement procedure. RS-HRU rate raged from 14. 8% (95% CI 13. 0-16. 7) in the Midwest to 20. 4% (18. 5-22. 3) in the South. RS-costs varied from 49, 303 (95% CI 47, 944-50, 665) in the Northeast to 59, 899 (95% CI 58, 432-61, 355) in the West. In-hospital mortality did not significantly differ by region. Sensitivity analysis excluding congenital AI admissions showed increased resource utilization and mortality. Conclusion: Substantial regional variation exists in ACHD resource utilization. Future studies will focus on specific procedure types and hospital characteristics to uncover potential region-specific strategies to optimize ACHD care as healthcare moves toward value-based models aligned with regional demands.
Díaz-Castrillón et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: