PM1012: The Impact of Health Insurance Coverage, Race, and Prenatal Diagnosis on Pediatric Cardiac Surgical Outcomes: A Pilot Study

Background: Over the past decade, the mortality rate for pediatric cardiac surgeries has decreased significantly. However, data from surgical centers has revealed continued disparities in outcomes. This pilot study analyzed surgical outcomes from a pediatric cardiology practice in a medium-sized city that is not associated with a surgery program. The aim was to determine whether surgical outcomes (mortality, readmissions, reoperations, length of stay, and the presence of post operative residual lesions) differed based on the surgical center volume to which the patient was referred.

Methods: This was a retrospective chart review of patients referred for congenital heart surgery between 2014 and 2019 from a private practice, not associated with a surgery center, using the practice’s surgical database. Predictor data points included race, ethnicity, sex, insurance status, surgical center volume, procedure STAT category (as determined by categories in the Society of Thoracic Surgeons Congenital Heart Disease Database (STSCHDD)), and the presence of prenatal diagnosis. Outcomes included length of stay, number of readmissions within 30 days of surgery, number of reoperations within 90 days of surgery, mortality within 30 days of surgery, and the presence of post-operative residual lesions. Relationships were analyzed with independent t-tests and chi-square analyses, as appropriate.

Results: The 30-day mortality rate was 1.9%. Primary analyses showed no significant relationships between predictors (race, ethnicity, sex, insurance status, surgical center volume) and outcomes (readmissions, reoperations, length of stay, mortality, and residual lesions), with two exceptions. First, the presence of a prenatal diagnosis was related to more readmissions, more reoperations, and longer length of stay. Second, lower STAT categories had fewer reoperations and shorter length of stay. Secondary analyses demonstrated a relationship between predictors. Insurance status and STAT category were related to prenatal diagnosis. In addition, race was related both to surgical center volume and to insurance status.

Conclusion: This small pilot study did not find a difference in clinical outcomes related to health insurance, race, or surgical center volume. However, important disparities were found. Children with private insurance were more likely to be diagnosed with congenital heart disease prenatally. Black children were more likely to be referred to medium-volume surgical centers. Historically, research has shown that high-volume surgical centers are associated with improved surgical outcomes. Follow up studies will explore factors that contribute to the disparity that exists in the prenatal diagnosis of congenital heart disease in patients with government funded insurance.