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Adesanya AM, Best KE, Coats L, Rankin J. Predictors of Post-Operative Hospital Length of Stay Following Complete Repair of Tetralogy of Fallot in a Pediatric Cohort in the North of England. Pediatr Cardiol 2024; 45:92-99. [PMID: 37698700 PMCID: PMC10776676 DOI: 10.1007/s00246-023-03287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
We sought to estimate the median post-operative length of stay (PLOS) and predictors of PLOS following tetralogy of Fallot (ToF) repair at a specialist surgical center in the North of England. The local National Congenital Heart Disease Audit dataset was used to identify patients aged < 2 years who underwent surgical repair for ToF between 1 January 1986 and 13 May 2022. Coefficients representing the median change in PLOS (days) according to predictors were estimated using Quantile regression. There were 224 patients (59.4% male, median age = 9 months, interquartile range (IQR) 5-13 months) with a median PLOS of 9 days (IQR 7-13). In the univariable regression, age (months) and weight (kg) at operation (β = - 0.17, 95% CI: - 0.33, - 0.01) and (β = - 0.53, 95% CI: - 0.97, - 0.10), previous (cardiac or thoracic) procedure (β = 5, 95% CI:2.38, 7.62), procedure urgency (elective vs urgent) (β = 2.8, 95% CI:0.39, 5.21), bypass time (mins) (β = 0.03, 95% CI:0.01, 0.05), cross-clamp time (mins) (β = 0.03, 95% CI:0.01, 0.06) and duration of post-operative intubation (days) (β = 0.81, 95% CI:0.67, 0.96), were significantly associated with PLOS. Previous procedure and intubation time remained significant in multivariable analyses. Some patient and operative factors can predict PLOS following complete ToF repair. Information on PLOS is important for health professionals to support parents in preparing for their child's discharge and to make any necessary practical arrangements. Health commissioners can draw on evidence-based guidance for resource planning. The small sample size may have reduced the power to detect small effect sizes, but this regional study serves as a foundation for a larger national study.
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Affiliation(s)
- Adenike M Adesanya
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Kate E Best
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise Coats
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK
- Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK
- NIHR Applied Research Collaboration North East and North Cumbria, Newcastle Upon Tyne, UK
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2
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Desai KD, Yuan I, Padiyath A, Goldsmith MP, Tsui FC, Pratap JN, Nelson O, Simpao AF. A Narrative Review of Multiinstitutional Data Registries of Pediatric Congenital Heart Disease in Pediatric Cardiac Anesthesia and Critical Care Medicine. J Cardiothorac Vasc Anesth 2023; 37:461-470. [PMID: 36529633 DOI: 10.1053/j.jvca.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Congenital heart disease (CHD) is one of the most common birth anomalies. While the care of children with CHD has improved over recent decades, children with CHD who undergo general anesthesia remain at increased risk for morbidity and mortality. Electronic health record systems have enabled institutions to combine data on the management and outcomes of children with CHD in multicenter registries. The application of descriptive analytics methods to these data can improve clinicians' understanding and care of children with CHD. This narrative review covers efforts to leverage multicenter data registries relevant to pediatric cardiac anesthesia and critical care to improve the care of children with CHD.
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Affiliation(s)
- Krupa D Desai
- Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Ian Yuan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Asif Padiyath
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michael P Goldsmith
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Fu-Chiang Tsui
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jayant Nick Pratap
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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3
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Abstract
PURPOSE OF REVIEW This article reviews the current understanding and limitations in knowledge of the effect genetics and genetic diagnoses have on perioperative and postoperative surgical outcomes in patients with congenital heart disease (CHD). RECENT FINDINGS Presence of a known genetic diagnosis seems to effect multiple significant outcome metrics in CHD surgery including length of stay, need for extracorporeal membrane oxygenation, mortality, bleeding, and heart failure. Data regarding the effects of genetics in CHD is complicated by lack of standard genetic assessment resulting in inaccurate risk stratification of patients when analyzing data. Only 30% of variation in CHD surgical outcomes are explained by currently measured variables, with 2.5% being attributed to diagnosed genetic disorders, it is thought a significant amount of the remaining outcome variation is because of unmeasured genetic factors. SUMMARY Genetic diagnoses clearly have a significant effect on surgical outcomes in patients with CHD. Our current understanding is limited by lack of consistent genetic evaluation and assessment as well as evolving knowledge and discovery regarding the genetics of CHD. Standardizing genetic assessment of patients with CHD will allow for the best risk stratification and ultimate understanding of these effects.
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Abstract
BACKGROUND Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay. METHODS We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed. RESULTS Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5-6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost. CONCLUSIONS Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.
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Ambrose SE, Ongkasuwan J, Dedhia K, Diercks GR, Anne S, Shashidharan S, Raol N. Analysis of Vocal Fold Motion Impairment in Neonates Undergoing Congenital Heart Surgery. JAMA Otolaryngol Head Neck Surg 2019; 144:406-412. [PMID: 29543970 DOI: 10.1001/jamaoto.2017.3459] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Vocal fold motion impairment (VFMI) is a known risk factor following congenital heart surgery (CHS). The impact of this diagnosis on utilization and outcomes is unknown. Objective To evaluate the cost, postprocedure length of stay (PPLOS), and outcomes for neonates with VFMI after CHS. Design, Setting, and Participants A cross-sectional analysis of the 2012 Kids' Inpatient Database (KID) of neonates who underwent CHS was carried out. The KID is an administrative data set of patients, aged 20 years or younger, and contains data on more than 10 million hospitalizations from 44 states. The KID is limited to inpatient hospitalization and contains discharge summary level of data. Patients were limited to those who were born during the hospitalization and those who were aged 28 days or younger at the time of admission for CHS. A weighted total of 4139 neonates who underwent CHS were identified, of which 3725 survived. The proportion of neonates diagnosed with VFMI was 264 (6.92%) of 3725. Exposures Congenital heart surgery. Main Outcomes and Measures Cost of inpatient hospital stay, postprocedure length of stay, odds of pneumonia, gastrostomy tube placement, and tracheostomy tube placement. Risk-adjusted generalized linear models examined differences in cost and PPLOS between neonates who underwent CHS and were diagnosed with VFMI and those who were not. Risk-adjusted logistic regression compared the odds of selected outcomes (gastrostomy, tracheostomy, pneumonia). Models were weighted to provide national estimates. Results Of 3725 neonates (aged 0-28 days), 2203 (59.1%) were male and 1517 (40.7%) were female. Neonates diagnosed with VFMI had significantly higher total cost by $34 000 (95% CI, 2200-65 000) and PPLOS by 9.1 days (95% CI, 4.6-13.7) compared with those who did not. When PPLOS was included as a covariate in the model for cost, presence of VFMI was no longer significant. There were no differences in odds of pneumonia, gastrostomy, or tracheostomy. Conclusions and Relevance Vocal fold motion impairment after CHS was associated with significant increases in cost owing to increased PPLOS. These findings provide a foundation to further investigate standardized screening for VFMI following CHS; early identification and treatment may decrease cost and PPLOS.
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Affiliation(s)
- Stephanie E Ambrose
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College Of Medicine, Houston, Texas.,Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Houston, Texas
| | - Kavita Dedhia
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Gillian R Diercks
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brookline, Massachusetts.,Massachusetts Eye and Ear Infirmary, Boston
| | - Samantha Anne
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Atlanta, Georgia
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Lawley CM, Winlaw DS, Sholler GF, Martin A, Badawi N, Walker K, Nassar N, Lain SJ. School-Age Developmental and Educational Outcomes Following Cardiac Procedures in the First Year of Life: A Population-Based Record Linkage Study. Pediatr Cardiol 2019; 40:570-579. [PMID: 30535960 DOI: 10.1007/s00246-018-2029-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to evaluate school-age developmental and educational outcomes for children with and without a cardiac procedure in the first year of life to improve understanding of longer-term neurodevelopmental outcomes in children who have had a cardiac procedure for congenital heart disease, the most common serious congenital anomaly. A population-based cohort study using record linkage of state-wide data was undertaken, evaluating children born in New South Wales, Australia, 2001-2007. Those with and without a cardiac procedure in the first year of life with a linked developmental (Australian version Early Development Instrument testing result, age 4-6 years) and/or educational outcome (Australian National Assessment Program result, age 7-9 years) were included. Perinatal, perioperative and sociodemographic factors were examined using multivariable logistic regression models. Of 468,329 eligible children, 768 had a cardiac procedure in the first year of life and 582 were included. For those with a cardiac procedure and developmental outcome (n = 260), 13.1% were classified as having 'special needs' compared to 4.4% without a cardiac procedure. Of those with an educational outcome, after adjusting for perinatal, perioperative and demographic variables, children with a cardiac procedure (n = 396) were twice as likely to score below National Minimum Standard in school literacy and numeracy tests compared to their peers. Significant predictors included low birthweight, parent not completing school and having > 4 re-hospitalisations in their first six years. The developmental and educational trajectory of children who have had a cardiac procedure in their first year remains altered into primary school years. While perioperative factors did not impact outcomes, ongoing health and sociodemographic factors were important in identifying those children at greatest risk.
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Affiliation(s)
- Claire M Lawley
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia. .,Heart Centre for Children, Sydney Children's Hospital Network, The Children's Hospital, Westmead, NSW, Australia. .,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - David S Winlaw
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Heart Centre for Children, Sydney Children's Hospital Network, The Children's Hospital, Westmead, NSW, Australia
| | - Gary F Sholler
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Heart Centre for Children, Sydney Children's Hospital Network, The Children's Hospital, Westmead, NSW, Australia
| | - Andrew Martin
- School of Education (Educational Psychology Research Group), University of New South Wales, Sydney, Australia
| | - Nadia Badawi
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Camperdown, NSW, Australia
| | - Karen Walker
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Camperdown, NSW, Australia
| | - Natasha Nassar
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Child Population Health Research, Westmead Clinical School, The Children's Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Samantha J Lain
- Child Population Health Research, Westmead Clinical School, The Children's Hospital, The University of Sydney, Sydney, NSW, Australia
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Predictors of Extended Length of Hospital Stay Following Surgical Repair of Congenital Heart Diseases. Pediatr Cardiol 2018; 39:1688-1699. [PMID: 30171266 DOI: 10.1007/s00246-018-1953-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/08/2018] [Indexed: 01/28/2023]
Abstract
The purpose of this study is to evaluate post-operative length of stay (LOS) following surgical repair of congenital heart defects (CHD) and to investigate baseline pre-operative factors and predictors of post-operative LOS (pLOS). Retrospective chart review of all cases of corrective surgery for CHD performed at the Pediatric Cardiology Unit, King Abdulaziz University Hospital, Jeddah during January 2013-December 2016. Baseline demographics, clinical factors, pre-operative, intra-operative, post-operative cardiac and extra-cardiac complications were analyzed as independent factors of pLOS using stepwise linear regression. Kaplan-Meier (KM) survival analysis was used to analyze the correlation of pLOS (in days) with the independent variables and estimate the probability to exceeding a given pLOS. A total 191 patients (52.4% male, 49.7% aged ≤ 1 year) were included with a median [range] LOS = 10 [3, 158] days. Several baseline clinical factors were associated with longer pLOS such as complex CHD types (tetralogy of Fallot, transposition of great arteries, etc.), high-risk RACHS categories and low weight at surgery. Independent risk factors of pLOS included pre-operative hemoglobin level (unstandardized regression coefficient: B = 2.96, p = 0.036) as the only pre-operative predictor of LOS, besides intra-operative complications (B = 11.72, p = 0.009) and posto-perative factors including MV duration (B = 9.39, p < 0.001), diet/feeding problems (B = 10.27, p = 0.001) and drain tube stay (B = 3.82, p = 0.003). KM survival curves confirmed that these factors increased the probability for longer LOS. Post-operative LOS was associated with several baseline and peri-operative factors; however, it was independently predicted by abnormal baseline hemoglobin level, the occurrence of intra-operative complications, besides post-operative feeding problems, chest drain stay, and MV duration.
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8
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Lisanti AJ, Golfenshtein N, Medoff-Cooper B. The Pediatric Cardiac Intensive Care Unit Parental Stress Model: Refinement Using Directed Content Analysis. ANS Adv Nurs Sci 2018; 40:319-336. [PMID: 28990967 PMCID: PMC5664220 DOI: 10.1097/ans.0000000000000184] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This descriptive, qualitative study used directed content analysis to explore and clarify specific foci of parental stress for mothers of infants with complex congenital heart disease in the pediatric cardiac intensive care unit (PCICU). The PCICU Parental Stress Model was used as the guiding theoretical framework. Three focus groups were conducted with 14 mothers of infants who were being cared for in a PCICU at a large mid-Atlantic children's hospital. Data provided themes to support and refine the PCICU Parental Stress Model that can be used to guide practice, education, and future research in this unique population and setting.
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Affiliation(s)
- Amy Jo Lisanti
- University of Pennsylvania, School of Nursing
- Children’s Hospital of Philadelphia
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9
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Greene CL, Mainwaring RD, Sidell D, Yarlagadda VV, Patrick WL, Hanley FL. Impact of Phrenic Nerve Palsy and Need for Diaphragm Plication Following Surgery for Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collaterals. Semin Thorac Cardiovasc Surg 2018; 30:318-324. [PMID: 29545034 DOI: 10.1053/j.semtcvs.2018.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/11/2022]
Abstract
Injury to the phrenic nerves may occur during surgery for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA-VSD and MAPCAs). These patients may develop respiratory failure and require diaphragm plication. The purpose of this study was to evaluate the impact of phrenic nerve palsy on recovery following surgery for PA-VSD and MAPCAs. Between 2007 and 2016, approximately 500 patients underwent surgery for PA-VSD and MAPCAs at our institution. Twenty-four patients (4.8%) subsequently had evidence of new phrenic nerve palsy. Sixteen patients were undergoing their first surgical procedure, whereas 8 were undergoing reoperations. All 24 patients underwent diaphragm plication. A cohort of matched controls was identified based on identical diagnosis and procedures but did not sustain a phrenic nerve palsy. Eighteen of the 24 patients (75%) had clinical improvement following diaphragm plication as evidenced by the ability to undergo successful extubation (5 ± 2 days), transition out of the intensive care unit (32 ± 16 days), and discharge from the hospital (42 ± 19 days). In contrast, there were 6 patients (25%) who did not demonstrate a temporal improvement following diaphragm plication, as evidenced by intervals of 61 ± 38, 106 ± 45, and 108 ± 46 days, respectively (P < 0.05 for all 3 comparisons). The 6 patients who failed to improve following diaphragm plication had a significantly greater number of comorbidities compared to the 18 patients who demonstrated improvement (2.2 vs 0.6 per patient, P < 0.05). When compared with the control group, patients who improved following diaphragm plication spent an additional 22 days and patients who failed to improve an additional 90 days in the hospital. The data demonstrate a bifurcation of clinical outcome in patients undergoing diaphragm plication following surgery for PA-VSD and MAPCAs. This bifurcation appears to be linked to the presence or absence of other comorbidities.
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Affiliation(s)
- Christina L Greene
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
| | - Douglas Sidell
- Division of Pediatric Otorhinolaryngology, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Vamsi V Yarlagadda
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - William L Patrick
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
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Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery. CHILDREN-BASEL 2017; 4:children4110101. [PMID: 29165381 PMCID: PMC5704135 DOI: 10.3390/children4110101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/02/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022]
Abstract
Introduction: This study aimed to determine factors associated with the need for extracorporeal membrane oxygenation (ECMO) in children with congenital heart disease (CHD) during admission for cardiac surgery (CS). A secondary aim was to determine how ECMO impacted length, cost, and mortality of the admission. Methods: Data from the Kids’ Inpatient Database (KIDS) were utilized. Admissions with CHD under 18 years of age with cardiac surgery were included. Need for ECMO in these admissions was then identified. Univariate analysis was conducted to compare characteristics between admissions with and without ECMO. Regression analyses were conducted to determine what factors were independently associated with ECMO and whether ECMO independently impacted admission characteristics. Results: A total of 46,176 admissions with CHD and CS were included in the final analysis. Of these, 798 (1.7%) required ECMO. Median age of ECMO admissions was 0.5 years. The following were associated with ECMO: decreased age, heart failure, acute kidney injury, arrhythmia, double outlet right ventricle, atrioventricular septal defect, transposition, Ebstein anomaly, hypoplastic left heart syndrome, common arterial trunk, tetralogy of Fallot, coronary anomaly, valvuloplasty, repair of total anomalous pulmonary venous connection, arterial switch, RV to PA conduit placement, and heart transplant (p < 0.01). ECMO independently increased length of stay by 17.8 days, cost of stay by approximately $415,917, and inpatient mortality 22-fold. Conclusion: Only a small proportion of CHD patients undergoing CS require ECMO, although these patients require increased resource utilization and have high mortality. Specific cardiac lesions, cardiac surgeries, and comorbidities are associated with increased need for ECMO.
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11
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Lawley CM, Lain SJ, Figtree GA, Sholler GF, Winlaw DS, Roberts CL. Mortality, rehospitalizations and costs in children undergoing a cardiac procedure in their first year of life in New South Wales, Australia. Int J Cardiol 2017; 241:156-162. [DOI: 10.1016/j.ijcard.2017.03.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
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12
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Floh AA, Zafurallah I, MacDonald C, Honjo O, Fan CPS, Laussen PC. The advantage of early plication in children diagnosed with diaphragm paresis. J Thorac Cardiovasc Surg 2017; 154:1715-1721.e4. [PMID: 28712584 DOI: 10.1016/j.jtcvs.2017.05.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/25/2017] [Accepted: 05/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In this single-center study, we sought to determine the frequency of phrenic nerve injury leading to diaphragm paresis (DP) in children following open cardiac surgery over the last 10 years, and to identify possible variables that predict the need for plication and associated clinical outcomes. METHODS Patients diagnosed with DP were identified from departmental databases and a review of clinical diaphragm ultrasound images. A cohort was analyzed for predictors of diaphragm plication and associations with clinical outcomes. Cumulative proportion graphs modeled the association between plication and length of stay. RESULTS DP was diagnosed in 161 of 6448 patients (2.5%) seen between January 2002 and December 2012. All diagnoses but 1 were confirmed by ultrasound. Plication of the diaphragm was performed in 30 patients (19%); compared with patients who did not undergo plication, these patients were younger (median age, 10 days vs 138 days; P < .001), more likely to have undergone deep hypothermic circulatory arrest (47% vs 18%; P = .005), had a longer duration of positive pressure ventilation (median, 15 days vs 7 days; P < .001), and had longer lengths of stay in both the intensive care unit (median, 23 days vs 8 days; P < .0001) and the hospital (median, 37 days vs 15 days; P < .0001). Early plication was associated with reduction in all intervals of care. CONCLUSIONS Early plication should be considered for patients with diaphragm paresis requiring prolonged respiratory support after cardiac bypass surgery. Longer follow-up evaluation is required to better define the long-term implications of plication.
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Affiliation(s)
- Alejandro A Floh
- Department of Critical Care Medicine and Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Intikhab Zafurallah
- Paediatric Intensive Care and KIDS Retrieval Service, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Cathy MacDonald
- Department of Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery and Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chun-Po S Fan
- Cardiovascular Data Management Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter C Laussen
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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13
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Mulkey SB, Bai S, Luo C, Cleavenger JE, Gibson N, Holland G, Mosley BS, Kaiser JR, Bhutta AT. School-Age Test Proficiency and Special Education After Congenital Heart Disease Surgery in Infancy. J Pediatr 2016; 178:47-54.e1. [PMID: 27453376 PMCID: PMC5295644 DOI: 10.1016/j.jpeds.2016.06.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/11/2016] [Accepted: 06/06/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate test proficiency and the receipt of special education services in school-age children who had undergone surgery for congenital heart disease (CHD) at age <1 year. STUDY DESIGN Data from Arkansas-born children who underwent surgery for CHD at Arkansas Children's Hospital at age <1 year between 1996 and 2004 were linked to state birth certificates and the Arkansas Department of Education longitudinal database containing achievement test scores in literacy and mathematics for grades 3-4 and special education codes. The primary negative outcome was not achieving grade-level proficiency on achievement tests. Logistic regression accounting for repeated measures was used to evaluate for associations between achieving proficiency and demographic data, maternal education, and clinical factors. RESULTS A total of 362 of 458 (79%) children who underwent surgery for CHD were matched to the Arkansas Department of Education database, 285 of whom had grade 3 and/or 4 achievement tests scores. Fewer students with CHD achieved proficiency in literacy and mathematics (P < .05) compared with grade-matched state students. Higher 5-minute Apgar score, shorter duration of hospitalization, and higher maternal education predicted proficiency in literacy (P < .05). White race, no cardiopulmonary bypass, and shorter hospitalization predicted proficiency in mathematics (P < .05). Sex, gestational age, age at surgery, CHD diagnosis, and type and number of surgeries did not predict test proficiency. Compared with all public school students, more children with CHD received special education services (26.9% vs 11.6%; P < .001). CONCLUSION Children with CHD had poorer academic achievement and were more likely to receive special education services than all state students. Results from this study support the need for neurodevelopmental evaluations as standard practice in children with CHD.
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Affiliation(s)
- Sarah B. Mulkey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR,Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Shasha Bai
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Chunqiao Luo
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Neal Gibson
- Arkansas Research Center, University of Central Arkansas, Conway, AR
| | - Greg Holland
- Arkansas Research Center, University of Central Arkansas, Conway, AR
| | - Bridget S. Mosley
- Section of Birth Defects Research, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jeffrey R. Kaiser
- Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Adnan T. Bhutta
- Department of Pediatrics, University of Maryland, Baltimore, MD
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