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508 A Risk-Adjusted Study of Outcome and Resource Utilization for Congenital Diaphragmatic Hernia.
  1. J. C. Lam,
  2. J. Claydon*,
  3. C. R. Mitton*,
  4. E. D. Skarsgard
  1. British Columbia Children's Hospital, and the Departments of Surgery (Pediatric Surgery)
  2. *Health Care and Epidemiology University of British Columbia, Vancouver, BC, Canada

Abstract

Purpose Perinatal care of infants with CDH is non-standardized and costly. We examined a risk-adjusted cohort of CDH patients and hypothesized that (1) amongst CDH survivors, the cost of the birth admission would be proportional to illness-severity, and (2) this cost would be significantly higher compared to a matched non-CDH cohort.

Methods A retrospective review of costs and outcomes for all patients with CDH admitted to British Columbia Children's Hospital between 1999 and 2003 was performed. Risk grouping of CDH patients using a validated, admission severity score (SNAP-II) was conducted, enabling comparison amongst infants surviving to discharge. Hospital costs were also compared to a non-CDH cohort matched for birth weight and SNAP-II.

Results 32 infants with CDH were included, of whom 5 required ECMO. 23 infants (72%) survived to discharge, with an average LOS of 46 days. Average cost per survivor to discharge was $54,102 (vs $13,722 for the non-CDH cohort; p < .05). Total costs for survivors were significantly correlated with SNAP-II at admission across lower risk groups (low number of survivors in the highest risk groups prevented further analysis).

Conclusions Infants born with CDH require costly care and can be expected to consume disproportionate resources. Admission SNAP-II score correlates with total cost to discharge among lower risk groups. Risk stratification and cost comparison of larger CDH populations may allow identification of cost-efficient treatment strategies.

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