Thorac Cardiovasc Surg 2010; 58(6): 322-327
DOI: 10.1055/s-0030-1249866
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Management of Congenital Heart Disease: Correlation between Hospital Costs and the Aristotle Complexity Score

N. Sinzobahamvya1 , T. Kopp2 , J. Photiadis1 , C. Arenz1 , E. Schindler3 , C. Haun4 , V. Hraska1 , B. Asfour1
  • 1Pediatric Cardio-Thoracic Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
  • 2Control Department, Asklepios Clinic, Sankt Augustin, Germany
  • 3Anesthesiology and Critical Care Medicine, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
  • 4Cardiac Intensive Care, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Further Information

Publication History

received Dec. 27, 2009

Publication Date:
07 September 2010 (online)

Abstract

Background: Hospital costs are expected to correlate with clinical complexity. Do costs for congenital heart surgery correlate with Aristotle complexity scores? Methods: 442 inpatient stays in 2008 were evaluated. Aristotle scores and levels were determined. Costs were estimated according to the German Institute for Hospital Reimbursement system. Pearson and Spearman r correlation coefficients and corresponding goodness-of-fit regression coefficients r2 were calculated. Results: Mean basic and comprehensive Aristotle scores were 7.60 ± 2.74 and 9.23 ± 2.94 points, respectively. Mean expenses per hospital stay amounted to 29 369 ± 30 823 Euros. Aristotle basic and comprehensive scores and levels were positively correlated with hospital costs. With a Spearman r of 1 and related r2 of 0.9436, scores of the 6 Aristotle comprehensive levels correlated best. Mean hospital reimbursement was 26 412 ± 17 962 Euros. Compensation was higher than expenses for patients in comprehensive levels 1 to 3, but much lower for those in levels 4 to 6. Conclusions: Aristotle comprehensive complexity scores were highly correlated with hospital costs. The Aristotle score could be used as a scale to establish the correct reimbursement after congenital heart surgery.

References

  • 1 Lacour-Gayet F, Clarke D, Jacobs J The Aristotle Committee et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results.  Eur J Cardiothorac Surg. 2004;  25 911-924
  • 2 Jacobs J P, Lacour-Gayet F G, Jacobs M L et al. Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results.  Ann Thorac Surg. 2005;  79 1635-1649
  • 3 O'Brien S M, Jacobs J P, Clarke D R, Maruszewski B et al. Accuracy of the Aristotle basic complexity score for classifying the mortality and morbidity potential of congenital heart surgery operations.  Ann Thorac Surg. 2007;  84 2027-2037
  • 4 Clarke D R, Lacour-Gayet F, Jacobs J P et al. The assessment of complexity in congenital cardiac surgery based on objective data.  Cardiol Young. 2008;  18 (Suppl. 2) 169-176
  • 5 Heinrichs J, Sinzobahamvya N, Arenz C et al. Surgical management of congenital heart disease: evaluation according to Aristotle score.  Eur J Cardiothorac Surg. 2010;  37 210-217
  • 6 Jenkins K J, Gauvreau K, Newburger J W, Spray T L, Moller J H, Iezzoni L I. Consensus-based method for risk adjustment for surgery for congenital heart disease.  J Thorac Cardiovasc Surg. 2002;  123 110-118
  • 7 O'Brien S M, Clarke D R, Jacobs J P et al. An empirically based tool for analyzing mortality associated with congenital heart surgery.  J Thorac Cardiovasc Surg. 2009;  138 1139-1153
  • 8 Munoz E, Josephson J, Tenenbaum N, Goldstein J, Shears A M, Wise L. Diagnosis-related groups, costs, and outcome for patients in the intensive care unit.  Heart Lung. 1989;  18 627-633
  • 9 Antioch K M, Walsh M K. The risk-adjusted vision beyond case mix (DRG) funding in Australia. International lessons in high complexity and capitation.  Eur J Health Econ. 2004;  5 95-109
  • 10 Benavidez O J, Connor J A, Gauvreau K, Jenkins K J. The contribution of complications to high resource utilization during congenital heart surgery admissions.  Congenit Heart Dis. 2007;  2 319-326

Dr. Nicodème Sinzobahamvya

Pediatric Cardio-Thoracic Surgery
Deutsches Kinderherzzentrum Sankt Augustin

Arnold-Janssen-Strasse 29

53757 Sankt Augustin

Germany

Phone: +49 22 41 24 96 01

Fax: +49 22 41 24 96 02

Email: n.sinzobahamvya@asklepios.com