Menon et al suggested that administrative databases are suboptimal for the study of “contemporary outcomes, surgical complications, and resource utilization” in hypoplastic left heart syndrome (HLHS), but they offer no data to support the opinion. Additionally, they suggest that their single-institution report, unlike administrative data, is “unbiased.” I fail to see how our reports on outcome and resource utilization covering >5,000 patients with HLHS cared for at >100 hospitals across the country are biased or how they fail to allow the study of contemporary outcomes or resource utilization. If anything, reporting of surgical results from a single institution might be more biased, to the extent that it might obscure institutional or regional differences. In fact, the data from the Intermountain West study closely replicate nationwide studies of mortality, complications, and resource utilization, and the comparison would have provided validity to their data. Study of nationally representative databases has provided insight into the effects of race, gender, and insurance status on mortality in congenital heart disease.

To be sure, there are limitations to the use of administrative databases of hospital discharges to study congenital heart disease, most notably the inability to follow individual patients over time to generate survival curves or to assess the cost of ambulatory care. Menon et al could have provided a more comprehensive summary of resource utilization in HLHS by including the charges for all of the outpatient visits, imaging studies, cardiac catheterizations, and physician fees, information generally not available in discharge data sets. Additionally, by apparently not including the costs of cardiac transplantation for HLHS, which exceeded $1 million in 21% of patients in our report, they may have underestimated the true cost of HLHS.