Low Parental Socioeconomic Position Results in Longer Post-Norwood Length of Stay

Abstract: Introduction Length of stay (LOS) has been proposed to be used as a quality metric in congenital heart surgery, but LOS may be influenced by parental socioeconomic position (SEP). We aimed to examine the relationship between post-Norwood LOS and SEP. Methods Patients undergoing a Norwood procedure from 2008-2018 for hypoplastic left heart syndrome (HLHS) from a single institution, who were discharged alive prior to second stage palliation, were included. SEP was defined by area deprivation index, distance from hospital, insurance status, and immigration status. A directed acyclic graph identified confounders for the effect of SEP on LOS, which included gestational age, HLHS subtype, post-operative cardiac arrest, reoperations, and ventilator days. A negative binomial model was used to assess effect of SEP on LOS. Results In total, 98 patients were discharged alive at a median 37 days (15th-85th percentile 26-72). The majority of patients were children of United States citizens and permanent residents (n=89, 91%). Private insurance covered 54 (55%), with 44 (45%) covered by Medicaid or Tricare. Median area deprivation index was 54 (25-87). Median distance travelled was 72 miles (17-469). For every 10 percentile increase in area deprivation index, LOS increased 4% (IRR 1.04, 95%CI 1.007-1.077, p=0.022). Insurance type, immigration status, and distance travelled did not affect post-operative length of stay. Conclusions There is a significant relationship between SEP and LOS. Consideration of LOS as a quality indicator may penalize hospitals providing care for patients with lower parental SEP.