The association of inborn status and resource utilization among neonates who received extracorporeal membrane oxygenation |
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| Institution: | 1. Department of Pediatrics, Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA;2. Fetal and Neonatal Institute, Division of Neonatology, Children''s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, UUSA;3. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;4. Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA;5. Division of Pediatric Surgery, Children''s Hospital Los Angeles, Los Angeles, USA;6. Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA |
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| Abstract: | BackgroundMany studies have established that extracorporeal membrane oxygenation (ECMO) can be a cost-effective treatment in some populations, but limited data exist on which factors are associated with length of stay (LOS) and total hospital costs. This study aimed to determine if inborn (i.e., cared for in their birth hospitals) neonates who receive ECMO have different resource utilization and outcomes compared to outborn (i.e., not cared for in their birth hospitals) neonates who receive ECMO.MethodsA retrospective cohort study was conducted using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 1997–2012. Neonates (infants, <28 days) placed on ECMO were categorized as either inborn or outborn. Salient clinical characteristics were compared between groups. A multivariable analysis was performed to identify the factors associated with length of stay (LOS), total hospital costs, and mortality in these two patient populations.ResultsOf 5,152 neonates receiving ECMO, 800 were inborn and 4,352 were outborn. Inborn neonates were more frequently diagnosed with cardiac-related diagnoses (70.5% vs 62.1%, p < 0.001). After adjusting for demographics and hospital-level factors, inborn neonates had longer hospital LOS (13.2 days, 95% CI, 8.7–18.7; p < 0.001), higher total encounter costs ($62,000, 95% CI, 40,000–85,000; p < 0.001) and higher mortality (OR 2.4, 95% CI 1.9–2.9; p < 0.001) compared to outborn neonates.ConclusionsInborn neonates placed on ECMO were more frequently diagnosed with cardiac-related diseases or congenital diaphragmatic hernia, had longer LOS, higher total encounter costs, and higher mortality rates relative to their outborn counterparts, and likely represent a higher risk population. These two populations of infants may be inherently different and their differences should be further explored to inform decision making about optimal site of delivery. |
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