Utilization patterns of extracorporeal membrane oxygenation in neonates in the United States 1997-2012

Ashley Y Song; Hsuan-Hsiu Annie Chen; Rachel Chapman; Ameish Govindarajan; Jeffrey S Upperman; Rita V Burke; James Stein; Philippe S Friedlich; Ashwini Lakshmanan

doi:10.1016/j.jpedsurg.2017.05.026

Utilization patterns of extracorporeal membrane oxygenation in neonates in the United States 1997-2012

J Pediatr Surg. 2017 Oct;52(10):1681-1687. doi: 10.1016/j.jpedsurg.2017.05.026. Epub 2017 Jun 1.

Authors

Ashley Y Song¹, Hsuan-Hsiu Annie Chen², Rachel Chapman², Ameish Govindarajan², Jeffrey S Upperman³, Rita V Burke³, James Stein³, Philippe S Friedlich², Ashwini Lakshmanan⁴

Affiliations

¹ 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, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
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, United States.
³ Department of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California.
⁴ 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, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States. Electronic address: alakshmanan@chla.usc.edu.

PMID: 28622971
DOI: 10.1016/j.jpedsurg.2017.05.026

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) remains one of the most intensive therapies for newborns in the United States. However, there is limited information on resource utilization for neonates receiving ECMO.

Methods: We conducted a retrospective data analysis of the Kids' Inpatient Database from 1997 to 2012. Bivariate and multivariate analysis was completed to identify predictors of LOS, hospital costs and mortality. Cardiac and non-cardiac diagnoses of neonates receiving ECMO were also included in the bivariate and multivariable analysis.

Results: Of the 5151 ECMO cases, survival to discharge was 62%. 22% had a principal cardiac diagnosis. After adjusting for covariates, increased mortality was associated with treatment in the midwest compared to the northeast region (aOR=2.0, p<0.01) and decreased among neonates with a non-cardiac diagnosis (aOR=0.4, p<0.01). Living in midwest was associated with longer LOS by 13days and increased hospital costs by 63,000 dollars (p<0.01). When stratified by non-cardiac diagnoses, infants with a diagnosis of congenital diaphragmatic hernia was associated with increased mortality (2.3, p<0.01) and longer LOS (25, p<0.01) and increased costs (11,100, p<0.01).

Conclusion: Neonates who received ECMO in certain regions of the United States were associated with poorer survival outcomes as well as increased LOS and hospital costs.

Type of study: Retrospective study.

Level of evidence: Level III.

Keywords: Charges; Costs; ECMO; Length of stay; Neonates; Outcomes; Utilization patterns.

MeSH terms

Extracorporeal Membrane Oxygenation / economics*
Extracorporeal Membrane Oxygenation / mortality
Extracorporeal Membrane Oxygenation / statistics & numerical data*
Female
Hernias, Diaphragmatic, Congenital / mortality
Hernias, Diaphragmatic, Congenital / therapy*
Hospital Costs
Humans
Infant
Infant, Newborn
Male
Multivariate Analysis
Retrospective Studies
Treatment Outcome
United States