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A comparison of hospital costs with reimbursement received for patients undergoing the Norwood procedure for hypoplasia of the left heart

Published online by Cambridge University Press:  16 September 2005

Vinod Mishra ,
Harald Lindberg ,
Egil Seem ,
Ingrid Klokkerud ,
Britt Fredriksen ,
Øyvind Skraastad ,
Anna Østlie ,
Sølvi Andresen  and
Stein Vaaler
Vinod Mishra
Affiliation:
Hospital Management/Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway
Harald Lindberg
Affiliation:
Department of Congenital Cardiac Surgery, Rikshospitalet University Hospital, Oslo, Norway
Egil Seem
Affiliation:
Department of Congenital Cardiac Surgery, Rikshospitalet University Hospital, Oslo, Norway
Ingrid Klokkerud
Affiliation:
Department of Congenital Cardiac Surgery, Rikshospitalet University Hospital, Oslo, Norway
Britt Fredriksen
Affiliation:
Pediatric Cardiothoracic Intensive Care Unit, Rikshospitalet University Hospital, Oslo, Norway
Øyvind Skraastad
Affiliation:
Department of Anaesthetics, Rikshospitalet University Hospital, Oslo, Norway
Anna Østlie
Affiliation:
Department of Anaesthetics, Rikshospitalet University Hospital, Oslo, Norway
Sølvi Andresen
Affiliation:
Hospital Management/Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway
Stein Vaaler
Affiliation:
Hospital Management, Rikshospitalet University Hospital, Oslo, Norway
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Abstract

Objectives: To determine whether the present system of reimbursement, based on diagnosis-related groups and regular financial budgeting, covers the costs incurred during hospitalisation of 7 children undergoing the three stages of the Norwood sequence for surgical treatment of hypoplastic left heart syndrome. Methods: Between January and September 2003, 7 patients underwent initial surgical palliation with the Norwood procedure at the Rikshospitalet University Hospital. A prospective methodology was developed by our group to measure the costs associated with each individual patient. The patients were closely observed, and the relevant data was collected during their stay in hospital. The stay was divided into four different periods of requirements of resources, defined as heavy intensive care, light intensive care, intermediate care, and ordinary care. At each stage, we recorded the number of staff involved and the duration of surgery and other major procedures, as well as the cost of pharmaceuticals and other consumables. Based on these data, we calculated the cost for each patient. These costs were compared with the corresponding revenue received by the hospital for each of the patients. Results: We found the total mean cost for the three stages of the Norwood sequence was 138,934 American dollars, while the corresponding revenue received by the hospital was 43,735 American dollars. During this period, one patient died during the first stage of the Norwood sequence. Conclusions: Our study shows that steps involved in the Norwood sequence are low-volume but high-cost procedures. The reimbursement received by our hospital for the procedures was less than one-third of the recorded costs.

Keywords

Hypoplastic left heart syndromein-hospital costdiagnosis-related groups
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 5 , October 2005 , pp. 493 - 497
Copyright
© 2005 Cambridge University Press

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References

Forbess JM, Cook N, Roth SJ, Serraf A, Mayer JE Jr, Jonas RA. Ten-year institutional experience with palliative surgery for hypoplastic left heart syndrome: risk factors related to stage I mortality. Circulation 1995; 11: II-262–II-266.Google Scholar
Morris CD, Outcalt J, Menashe VD. Hypoplastic left heart syndrome: natural history in a geographically defined population. Pediatrics 1990; 85: 977–983.Google Scholar
Noonan JA, Nadas AS. The hypoplastic left heart syndrome: an analysis of 101 cases. Paedtr Clin North Am 1958; 5: 1029–1056.Google Scholar
Norwood WI, Kirklin JK, Sanders SP. Hypoplastic left heart syndrome: experience with palliative surgery. Am J Cardiol 1980; 45: 78–91.Google Scholar
Norwood WI. Hypoplastic left heart syndrome. Ann Thorac Surg 1991; 52: 688–695.Google Scholar
Edbrooke DL, Hibbert CL, Kingsley JM, Smith S, Bright NM, Quinn JM. The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit. Crit Care Med 1999; 27: 1760–1767.Google Scholar
Terry J, Jenny W, Lisa L, Robert W. Data compatibility in patient level clinical costing. Casemix Quarterly number 1, March 31, 1999.
Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresia – hypoplastic left heart syndrome. New Eng J Med 1983; 308: 23–25.Google Scholar
Ishino K, Stumper O, De Giovanni JJ, et al. The modified Norwood procedures for hypoplastic left heart syndrome: early to intermediate results of 120 patients with particular reference to aortic arch repair. J Thorac Cardiovasc Surg 1999; 117: 920–930.Google Scholar
Kern JH, Hayes CJ, Michler RE, Gersony WM, Quaegebeur JM. Survival and risk factor analysis for the Norwood procedure for hypoplastic left heart syndrome. Am J Cardiol 1997; 80: 170–174.Google Scholar
Jacobs ML, Blackstone EH, Bailey LL. Intermediate survival in neonates with aortic atresia: a multi-institutional study. The Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg 1998; 116: 417–431.Google Scholar
Williams DL, Gelijns AC, Moskowitz AJ, et al. Hypoplastic left heart syndrome: valuing the survival. J Thorac Cardiovasc Surg 2000; 119 (4 Pt 1): 720–731.Google Scholar
Gutgesell HP, Massaro TA. Management of hypoplastic left heart syndrome in a consortium of university hospitals. Am J Cardiol 1995; 76: 809–811.Google Scholar
Benzaquen BS, Einsberg MJ, Challapalli R, Nguyen T, Brown KJ, Topol EJ. Correlates of in-hospital cost among patients undergoing abdominal aortic aorta aneurysm repair. Am Heart J 1998; 136: 373–381.Google Scholar
Gowper PA, DeLong ER, Peterson ED, et al. Geographic variation in resource use for coronary artery bypass surgery. Med Care 1997; 35: 320–333.Google Scholar
Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg 2000; 191: 123–130.Google Scholar