Trends in procedure choice, cost, and health outcomes in infants undergoing Stage 1 palliation for hypoplastic left heart syndrome: a retrospective analysis of the Paediatric Health Information System

Management of infants with hypoplastic left heart syndrome is resource-intensive. Trends in initial Stage 1 palliation choice and associated hospital cost and outcomes over time are unclear.Using a retrospective cohort of infants <30 days of age (2004-22) from the Paediatric Health Information Systems database, we analysed the annual prevalence of Stage 1 palliation choice, as well as the association between palliation choice and outcomes and resource use. Prevalence of palliation choice was calculated, and Mann-Kendall tests evaluated linear trends. Study outcomes were pooled across years and compared by palliation choice. Associations over time between palliation choice and outcomes and resource use were evaluated with generalised linear mixed models.Of 7701 patients, 67.45% (<i>n</i> = 5194) underwent a Norwood with modified Blalock-Taussig shunt, (NmBT) 22.06% (<i>n</i> = 1699) underwent a Norwood with right ventricle to pulmonary artery conduit (NRVPA), and 10.49% (<i>n</i> = 808) underwent a hybrid procedure. The annual prevalence of NRVPA surpassed that of NBT in 2017. In the pooled analysis, infants undergoing NRV-PA had the lowest in-hospital mortality (11.2%, <i>P</i> < 0.0001) and lowest cost at $335,406 (IQR: $208,624 to $583,322 (<i>P</i> = 0.001). A trend for increased median estimated hospitalisation cost was observed across time for all procedure choices (<i>P</i> for trend <0.0001 for all).These data suggest that the NRV-PA is the preferred palliation choice, has the lowest in-hospital mortality, and is the most cost-effective option. Our findings suggest that all Stage 1 palliation options have become more expensive with no observed change in mortality.