{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T05:10:30Z","timestamp":1779426630631,"version":"3.53.1"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>Using a retrospective cohort of infants &lt;30 days of age (2004\u201322) 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\u2013Kendall 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.<\/jats:p>\n                  <jats:p>\n                    Of 7701 patients, 67.45% (\n                    <jats:italic>n<\/jats:italic>\n                    = 5194) underwent a Norwood with modified Blalock-Taussig shunt, (NmBT) 22.06% (\n                    <jats:italic>n<\/jats:italic>\n                    = 1699) underwent a Norwood with right ventricle to pulmonary artery conduit (NRVPA), and 10.49% (\n                    <jats:italic>n<\/jats:italic>\n                    = 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%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.0001) and lowest cost at $335,406 (IQR: $208,624 to $583,322 (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.001). A trend for increased median estimated hospitalisation cost was observed across time for all procedure choices (\n                    <jats:italic>P<\/jats:italic>\n                    for trend &lt;0.0001 for all).\n                  <\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1017\/s1047951125109992","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T07:47:02Z","timestamp":1759736822000},"page":"2037-2043","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1017","volume":"35","author":[{"given":"Adam","family":"Dziacky","sequence":"first","affiliation":[{"name":"Johns Hopkins All Children\u2019s Pediatric Residency Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Morrison","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital"},{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Fierstein","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital"},{"name":"Johns Hopkins School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2498-3462","authenticated-orcid":false,"given":"Joyce","family":"Johnson","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"S1047951125109992_ref11","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312448"},{"key":"S1047951125109992_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.04.127"},{"key":"S1047951125109992_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.08.020"},{"key":"S1047951125109992_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)39288-8"},{"key":"S1047951125109992_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.01.013"},{"key":"S1047951125109992_ref12","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.065192"},{"key":"S1047951125109992_ref19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912461"},{"key":"S1047951125109992_ref16","unstructured":"16. Children\u2019s Hospital Association. Pediatric Health Information Systems (PHIS), 2022. https:\/\/www.childrenshospitals.org\/programs-and-services\/data-analytics-and-research\/pediatric-analytic-solutions\/pediatric-health-information-system. Accessed April 6, 2023."},{"key":"S1047951125109992_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2021.12.040"},{"key":"S1047951125109992_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2023.05.005"},{"key":"S1047951125109992_ref10","doi-asserted-by":"publisher","DOI":"10.1177\/2150135117752896"},{"key":"S1047951125109992_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.06.071"},{"key":"S1047951125109992_ref7","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2019.10.75"},{"key":"S1047951125109992_ref8","doi-asserted-by":"publisher","DOI":"10.1177\/2150135111434946"},{"key":"S1047951125109992_ref18","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951115002498"},{"key":"S1047951125109992_ref14","doi-asserted-by":"publisher","DOI":"10.4103\/sja.SJA_543_18"},{"key":"S1047951125109992_ref22","doi-asserted-by":"publisher","DOI":"10.1258\/jrsm.2011.110180"},{"key":"S1047951125109992_ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-018-1885-9"},{"key":"S1047951125109992_ref1","first-page":"10","article-title":"Hypoplastic left heart syndrome: a new paradigm for an old disease","volume":"6","author":"Grossfeld","year":"2019","journal-title":"J cardiovasc Dev Dis"},{"key":"S1047951125109992_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-14-199"},{"key":"S1047951125109992_ref2","unstructured":"2. Centers for Disease Control and Prevention (CDC). Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defects--United States, 2003. 2007; 56: 25\u201329"},{"key":"S1047951125109992_ref5","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2004.02.023"},{"key":"S1047951125109992_ref9","doi-asserted-by":"publisher","DOI":"10.1017\/S104795111800135X"}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951125109992","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T05:00:28Z","timestamp":1779426028000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1047951125109992\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":23,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["S1047951125109992"],"URL":"https:\/\/doi.org\/10.1017\/s1047951125109992","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"value":"1047-9511","type":"print"},{"value":"1467-1107","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}