508 A Risk-Adjusted Study of Outcome and Resource Utilization for Congenital Diaphragmatic Hernia. (1st January 2006) - Lam, J. C.
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.