• John A Romley, Alex Y Chen, Dana P Goldman, and Roberta Williams.
• Price School of Public Policy, University of Southern California, Los Angeles, CA.
• Health Serv Res. 2014 Apr 1;49(2):588-608.

ObjectiveTo determine the association between hospital costs and risk-adjusted inpatient mortality among children undergoing surgery for congenital heart disease (CHD) in U.S. acute-care hospitals.Data Sources/Study SettingsRetrospective cohort study of 35,446 children in 2003, 2006, and 2009 Kids' Inpatient Database (KID).Study DesignCross-sectional logistic regression of risk-adjusted inpatient mortality and hospital costs, adjusting for a variety of patient-, hospital-, and community-level confounders.Data Collection/Extraction MethodsWe identified relevant discharges in the KID using the AHRQ Pediatric Quality Indicator for pediatric heart surgery mortality, and linked these records to hospital characteristics from American Hospital Association Surveys and community characteristics from the Census.Principal FindingsChildren undergoing CHD surgery in higher cost hospitals had lower risk-adjusted inpatient mortality (p=.002). An increase from the 25th percentile of treatment costs to the 75th percentile was associated with a 13.6 percent reduction in risk-adjusted mortality.ConclusionsGreater hospital costs are associated with lower risk-adjusted inpatient mortality for children undergoing CHD surgery. The specific mechanisms by which greater costs improve mortality merit further exploration.© Health Research and Educational Trust.

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