Author + information
- Received July 7, 2015
- Revision received September 4, 2015
- Accepted September 8, 2015
- Published online January 11, 2016.
- Yinn Khurn Ooi, MD∗,†∗ (, )
- Michael Kelleman, MSPH†,
- Alexandra Ehrlich, MPH∗,
- Michelle Glanville, MBA, MHA∗,
- Arlene Porter, MSN∗,
- Dennis Kim, MD, PhD∗,†,
- Brian Kogon, MD∗,† and
- Matthew E. Oster, MD, MPH∗,†
- ∗Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
- †Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- ↵∗Reprint requests and correspondence:
Dr. Yinn Khurn Ooi, Children’s Healthcare of Atlanta, Division of Cardiology, 1405 Clifton Road NE, Atlanta, Georgia 30322.
Objectives The purpose of this study was to determine whether a transcatheter procedure or surgical closure offers a better value proposition for atrial septal defect (ASD) closure.
Background Secundum ASDs are common congenital heart defects with both transcatheter and surgical treatment options. Although both options have been shown to have excellent results in children, the relative value of the 2 procedures is unclear.
Methods Using data from the Pediatric Hospital Information System for 2004 to 2012, we compared the value of transcatheter versus surgical ASD closure for children ages 1 to 17 years, with value being defined as outcomes relative to costs. Total charges for procedure-related encounters were converted to costs using hospital-specific cost-to-charge ratios, and all costs were adjusted for inflation to reflect 2012 dollars.
Results There were 4,606 transcatheter procedures and 3,159 surgeries at 35 children’s hospitals. Those undergoing transcatheter closure were more likely to be older (5.6 years vs. 4.5 years, p < 0.0001). There was no mortality in either group. Children with a surgical procedure had a longer length of stay (4.0 days vs. 1.5 days, p < 0.0001), were more likely to have an infection (odds ratio: 3.73, p < 0.0001) or procedural complication (odds ratio: 6.66, p < 0.0001). Costs for transcatheter procedure encounters were lower than costs for surgical encounters (mean of $19,128 vs. $25,359, p < 0.0001).
Conclusions Both transcatheter and surgical ASD closure had excellent short-term outcomes, but transcatheter procedures had lower lengths of stay, rates of infection, and complications, resulting in lower overall costs. For children who are eligible, transcatheter ASD closure provides better short-term value than surgery.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 7, 2015.
- Revision received September 4, 2015.
- Accepted September 8, 2015.
- 2016 American College of Cardiology Foundation