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Keywords:

  • Health care costs;
  • health policy;
  • quality of care;
  • pediatrics;
  • geographic variation;
  • acute inpatient care

Objective

To determine the association between hospital costs and risk-adjusted inpatient mortality among children undergoing surgery for congenital heart disease (CHD) in U.S. acute-care hospitals.

Data Sources/Study Settings

Retrospective cohort study of 35,446 children in 2003, 2006, and 2009 Kids' Inpatient Database (KID).

Study Design

Cross-sectional logistic regression of risk-adjusted inpatient mortality and hospital costs, adjusting for a variety of patient-, hospital-, and community-level confounders.

Data Collection/Extraction Methods

We identified relevant discharges in the KID using the AHRQ Pediatric Quality Indicator for pediatric heart surgery mortality, and linked these records to hospital characteristics from American Hospital Association Surveys and community characteristics from the Census.

Principal Findings

Children undergoing CHD surgery in higher cost hospitals had lower risk-adjusted inpatient mortality (p = .002). An increase from the 25th percentile of treatment costs to the 75th percentile was associated with a 13.6 percent reduction in risk-adjusted mortality.

Conclusions

Greater hospital costs are associated with lower risk-adjusted inpatient mortality for children undergoing CHD surgery. The specific mechanisms by which greater costs improve mortality merit further exploration.