2018 May

Ventricular assist devices (VADs) have evolved into a vital mechanical support option in pediatrics.  VADs require specialized care and often involve lengthy hospital stays that impose a significant financial burden on a patient’s family and the hospital.  Stoke is a major adverse event associated with pediatric VADs, which has a strong negative impact on patient well-being; complicates care; and escalates cost.  The Pediatric Health Information System ® (PHIS) was utilized to estimate the incremental health care cost associated with stroke during VAD hospitalization.  The PHIS hospitals include 49 of the largest children's hospitals in the US.  From 2004-2017, 678 durable VADs were implanted in patients ≤18 years old.  From VAD implant to hospital discharge or death, 493 (72%) were free of stroke and 185 (27%) experienced a stroke event.  A stroke event added a median of 9 days to postoperative length of stay.  Estimated cost was determined by multiplying adjusted total charges by cost to charge ratio for each encounter based on the hospital and discharge.  The cost was then adjusted by the CMS wage/price index for the hospital’s location.  The median adjusted estimated cost of VAD treatment without stroke was $524,742 (IQR $330,630; $795,240) whereas a VAD treatment involving a stroke cost a median of $799,232 (IQR $502,245; $1,085,093), an increase of $274,490 due to stoke.  Stroke in VAD patients complicates care, decreases hospital survival (80% vs 60%), and results in in an increased cost of more than $250,000 per patient.

*By: John Broderick, Approved by PHIS