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Impact of pediatric cardiac surgery regionalization on health care utilization and mortality

Objective: Regionalization directs patients to highvolume hospitals for specialized care. We investigated regionalization trends and outcomes in pediatric cardiac surgery.

Data Sources/Study Setting: Statewide inpatient data from eleven states between 2000 and 2012.

Study Design: Mortality, length of stay (LOS), and cost were assessed using multivariable hierarchical regression with state and year fixed effects. Primary predictor was hospital casevolume, categorized into low, medium, and highvolume tertiles.

Data Collection/Extraction Methods: We used Risk Adjustment for Congenital Heart Surgery1 (RACHS1) to select pediatric cardiac surgery discharges.

Principal Findings: In total, 2841 (8.5 percent), 8348 (25.1 percent), and 22 099 (66.4 percent) patients underwent heart surgeries in low, medium, and highvolume hospitals. Mortality decreased over time, but remained higher in low and mediumvolume hospitals. Highvolume hospitals had lower odds of mortality and cost than lowvolume hospitals (odds ratio [OR] 0.59, <0.01, and relative risk [RR] 0.91, <0.01, respectively). LOS was longer for high and mediumvolume hospitals, compared to lowvolume hospitals (highvolume: RR 1.18, <0.01; mediumvolume: RR 1.05, <0.01).

Conclusions: Regionalization reduced mortality and cost, indicating fewer complications, but paradoxically increased LOS. Further research is needed to explore the full impact on health care utilization.

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