Key result
Pediatric cardiac surgery is linked to an almost 3-fold higher chronic medication burden.
Why the study?
As children with congenital heart defects increasingly survive beyond early childhood, understanding their longitudinal disease burden is imperative.
Does a history of pediatric cardiac surgery increase chronic medication use and expenditures in Medicaid-enrolled children compared to the general pediatric population?
Cohort (n=4,505,459)
Yes
Does a history of pediatric cardiac surgery increase chronic medication use and expenditures in Medicaid-enrolled children compared to the general pediatric population?
Children who undergo cardiac surgery experience a persistently high chronic medication burden and healthcare expenditure throughout childhood compared to the general pediatric population.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This study demonstrates that medication burden, and likely chronic disease burden, for children with congenital heart defects extends for far longer — for years — after surgery. Nearly half of adolescents with a history of cardiac surgery used more than one medication.”
High chronic medication burden after pediatric cardiac surgery warrants ongoing review; this Level-3 finding leaves open whether targeted interventions reduce long-term use.
BACKGROUND: Congenital heart defects are the most common and resource-intensive birth defects. As children with congenital heart defects increasingly survive beyond early childhood, it is imperative to understand longitudinal disease burden. OBJECTIVES: The purpose of this study was to examine chronic outpatient prescription medication use and expenditures for New York State pediatric Medicaid enrollees, comparing children who undergo cardiac surgery (cardiac enrollees) and the general pediatric population. METHODS: This was a retrospective cohort study of all Medicaid enrollees age <18 years using the New York State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources database (2006-2019). Primary outcomes were total chronic medications per person-year, enrollees per 100 person-years using ≥1 and ≥3 medications, and medication expenditures per person-year. We described and compared outcomes between cardiac enrollees and the general pediatric population. Among cardiac enrollees, multivariable regression examined associations between outcomes and clinical characteristics. RESULTS: We included 5,459 unique children (32,131 person-years) who underwent cardiac surgery and 4.5 million children (22 million person-years) who did not. More than 4 in 10 children who underwent cardiac surgery used ≥1 chronic medication compared with approximately 1 in 10 children who did not have cardiac surgery. Medication expenditures were 10 times higher per person-year for cardiac compared with noncardiac enrollees. Among cardiac enrollees, disease severity was associated with chronic medication use; use was highest among infants; however, nearly one-half of adolescents used ≥1 chronic medication. CONCLUSIONS: Children who undergo cardiac surgery experience high medication burden that persists throughout childhood. Understanding chronic medication use can inform clinicians (both pediatricians and subspecialists) and policymakers, and ultimately the value of care for this medically complex population.
No takes yet. Share an insight, caveat, or question.
Woo et al. (2023) conducted a cohort in Congenital heart defects (n=4,505,459). Cardiac surgery for congenital heart defects vs. General pediatric Medicaid population without cardiac surgery was evaluated on Enrollees per 100 person-years using ≥1 chronic medication. Children who underwent cardiac surgery experienced a significantly higher chronic medication burden, with 41 per 100 person-years using at least one chronic medication compared to 15 per 100 person-years in the general pediatric Medicaid population.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: