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Skaff AM, Valikodath NG, Godown J, Parra DA. "In-patient echocardiography utilization post repair of congenital heart disease. Analysis of data from the Pediatric Health Information System from 2010 to 2019". Cardiol Young 2024:1-6. [PMID: 38163984 DOI: 10.1017/s1047951123004407] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND Echocardiography is a key diagnostic tool for medical decision-making following congenital heart surgery. Overall utilisation of echocardiography for specific congenital heart lesions following cardiac surgery has not previously been reported. This study aims to assess echocardiogram utilisation following the surgical repair of CHD to describe the variation in use across centres and provide clinical benchmarks. METHODS All patients < 18 years of age undergoing surgical repair of CHD were identified from the Pediatric Health Information System from 2010 to 2019. Surgeries were grouped based on their Risk Adjustment for Congenital Heart Surgery-1 scores. Detailed billing data were used to assess the frequency/cost of post-operative echocardiograms, phase of hospital care, and hospital length of stay. RESULTS In total, 37,238 surgical encounters were identified for inclusion across 48 centres. Higher Risk Adjustment for Congenital Heart Surgery scores were associated with an increased median number of post-operative echocardiograms (2 versus 4 in Risk Adjustment for Congenital Heart Surgery score 1 versus 6, p < 0.001), and longer median post-operative length of stay (3 days versus 31 days in Risk Adjustment for Congenital Heart Surgery score 1 versus 6, p < 0.001). After accounting for surgical complexity, there was significant variability in echocardiogram utilisation across centres (median daily echocardiogram utilisation range 0.2/day-0.6/day, p < 0.001). There is no difference in the proportion of patients with high surgical complexity (Risk Adjustment for Congenital Heart Surgery ≥ 4) between centres with high versus low echocardiogram utilisation (p = 0.44). CONCLUSIONS Increasing surgical complexity is associated with longer post-operative length of stay and increased utilisation of echocardiography. There is wide variability in echocardiography resource utilisation across centres, even when accounting for surgical complexity.
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Affiliation(s)
- Adam M Skaff
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nishma G Valikodath
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Godown
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David A Parra
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Erickson LA, Ricketts A, Swanson T, Weiner J, Hasnie UA, Bonessa K, Noel-Macdonnell J, Russell CL. Determinants of Length of Stay after Neonatal Cardiac Surgery Using Path Analysis. West J Nurs Res 2023; 45:306-315. [PMID: 36217759 DOI: 10.1177/01939459221129037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
After neonatal cardiac surgery, families, and the health care team strive for exclusive oral feedings before hospital discharge. With the hypothesis that exclusive oral feedings would reduce the length of stay (LOS), a multidimensional path analysis was used to examine a cross-section of 280 neonates from 2009 to 2013. Buttigieg, Abela, and Pace's theoretical framework of structural and process-related determinants of LOS was modeled with hypothesis-driven correlation and directionality. The recursive path model had a good global and local fit with outcome variances of 26% for exclusive oral feeding and LOS. In the full cohort and model groups (single and biventricular), when controlling for covariances: sepsis, birth distance, necrotizing enterocolitis, genetic differences, specialty consults, the age at which neonatal cardiac surgery occurred (β = .23, p ≤ .001) and the duration of postoperative intubation (β = .47, p ≤ .001) more significantly influenced the LOS than intermediate mediation of exclusive oral feedings at discharge.
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Affiliation(s)
- Lori A Erickson
- Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amy Ricketts
- Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tara Swanson
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Julie Weiner
- Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
| | - Usman A Hasnie
- University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Haxel CS, Johnson JN, Hintz S, Renno MS, Ruano R, Zyblewski SC, Glickstein J, Donofrio MT. Care of the Fetus With Congenital Cardiovascular Disease: From Diagnosis to Delivery. Pediatrics 2022; 150:189887. [PMID: 36317976 DOI: 10.1542/peds.2022-056415c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The majority of congenital cardiovascular disease including structural cardiac defects, abnormalities in cardiac function, and rhythm disturbances can be identified prenatally using screening obstetrical ultrasound with referral for fetal echocardiogram when indicated. METHODS Diagnosis of congenital heart disease in the fetus should prompt assessment for extracardiac abnormalities and associated genetic abnormalities once maternal consent is obtained. Pediatric cardiologists, in conjunction with maternal-fetal medicine, neonatology, and cardiothoracic surgery subspecialists, should counsel families about the details of the congenital heart defect as well as prenatal and postnatal management. RESULTS Prenatal diagnosis often leads to increased maternal depression and anxiety; however, it decreases morbidity and mortality for many congenital heart defects by allowing clinicians the opportunity to optimize prenatal care and plan delivery based on the specific lesion. Changes in prenatal care can include more frequent assessments through the remainder of the pregnancy, maternal medication administration, or, in selected cases, in utero cardiac catheter intervention or surgical procedures to optimize postnatal outcomes. Delivery planning may include changing the location, timing or mode of delivery to ensure that the neonate is delivered in the most appropriate hospital setting with the required level of hospital staff for immediate postnatal stabilization. CONCLUSIONS Based on the specific congenital heart defect, prenatal echocardiogram assessment in late gestation can often aid in predicting the severity of postnatal instability and guide the medical or interventional level of care needed for immediate postnatal intervention to optimize the transition to postnatal circulation.
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Affiliation(s)
- Caitlin S Haxel
- The University of Vermont Children's Hospital, Burlington, Vermont
| | | | - Susan Hintz
- Stanford University, Lucille Salter Packard Children's Hospital, Palo Alto, California
| | - Markus S Renno
- University Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Julie Glickstein
- Columbia University Vagelos School of Medicine, Morgan Stanley Children's Hospital, New York, New York
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Abdelrehim AR, Al-Muhaya M, Alkodami AA, Baangood LS, Al-Mutairi M, Quadeer A, Alabsi FA, Alashwal M, Morsy MMF, Alnajjar AA, Salem SS. Predictors of major adverse events and complications after ventricular septal defects surgical closure in children less than 10 kg. J Cardiothorac Surg 2022; 17:232. [PMID: 36071526 PMCID: PMC9450295 DOI: 10.1186/s13019-022-01985-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Ventricular septal defect (VSD) is the most common congenital cardiac defect for which outcomes are not uniform. There is a lack of consensus on the risk factors for the unfavorable outcomes following surgical VSD closure. Aim The aim of this study was to determine the risk factors and the predictors of major adverse events (MAEs) and complications following surgical closure of VSD in children weighing less than 10 kg. Methods This retrospective cohort study included children less than 10 kg who underwent surgical closure of congenital VSD of any type with or without associated congenital heart diseases. Patients with associated major cardiac anomalies were excluded. Preoperative, operative and postoperative data were collected from medical records. Results This study included 127 patients 52.8% were males, the median age was 8.0 months (IQR = 6.0–11.0 months), and their median weight was 5.7 kg (IQR = 4.8–7.0). Mortality was in one patient (0.8%) Multivariable logistic regression analysis revealed that male sex group (observational data), previous pulmonary artery banding (PAB), and significant intraoperative residual VSD were significant risk factors for the development of MAEs (odds ratios were 3.398, 14.282, and 8.634, respectively). Trisomy 21 syndrome (odds ratio: 5.678) contributed significantly to prolonged ventilation. Pulmonary artery banding (odds ratio: 14.415), significant intraoperative (3 mm) residual VSD (odds ratio: 11.262), and long cross-clamp time (odds ratio: 1.064) were significant predictors of prolonged ICU stay, whereas prolonged hospital stay was observed significantly in male sex group (odds ratio: 12.8281), PAB (odds ratio: 2.669), and significant intraoperative (3 mm) residual VSD (odds ratio: 19.551). Conclusions Surgical VSD repair is considered a safe procedure with very low mortality. Trisomy 21 was a significant risk factor for prolonged ventilation. Further, PAB, significant intraoperative residual of 3 mm or more that required a second pulmonary bypass, and a greater cross-clamp time were significant predictors of MAE and associated complications with prolonged ICU and hospital stay.
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Affiliation(s)
- Ayman R Abdelrehim
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia. .,Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt.
| | - Mustafa Al-Muhaya
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Alassal A Alkodami
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Luna S Baangood
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Mansour Al-Mutairi
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Abdul Quadeer
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Fath A Alabsi
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - M Alashwal
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia
| | - Mohamed Mofeed F Morsy
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia.,Pediatric Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Sherif S Salem
- Pediatric Cardiac Services, Madinah Cardiac Center MCC, Madinah, Saudi Arabia.,Pediatric Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
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Huang SW, Hsu WF, Li HY, Hwang B, Wu FY, Weng ZC, Chuang CM, Chen SJ, Wang CC, Wang DS, Lee PC. Implantation of monocusp valve prolongs the duration of chest tube drainage in children with tetralogy of fallot after corrective surgery. J Chin Med Assoc 2022; 85:364-368. [PMID: 34670223 DOI: 10.1097/jcma.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Right ventricular outflow tract obstruction relief is one of the major procedures during the total correction of tetralogy of Fallot (TOF). Pulmonary insufficiency (PI) is usually inevitable after a transannular incision with a patch repair is performed. Therefore, some surgeons advocate to place a monocusp valve within the transannular patch (TAP) in order to decrease the severity of the PI. However, the monocusp valve seemed not be very effective in some patients who underwent the complete TOF repair. METHODS Patients who had the classic form of TOF between January 2009 and January 2017 and underwent the corrective surgery with a TAP by the same cardiovascular surgeon were identified for further analysis. Clinical information including demographics at operation, perioperative data, and postoperative outcome were collected retrospectively and compared between the group with and without a monocusp valve. RESULTS A total of 24 TOF cases were included in the final analysis, and 16 (66.7%) patients received a monocusp valve placement. The patients' characteristics before and during the surgery were similar between the two groups. The median duration of chest tube drainage after the total correction in the monocusp group was longer than those without the valve (p = 0.04). There was no difference in the immediate postoperative data, including the inflammation/infection status, the duration of mechanical ventilation, and the length of ICU and hospital stay. CONCLUSION Implantation of a monocusp valve during the total TOF correction using a TAP did not bring benefit to improve the immediate postoperative outcomes, especially the duration of the pleural drainage. Further study with a prospective design and a larger number of cases is needed.
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Affiliation(s)
- Shao-Wei Huang
- Division of Pediatric cardiology, Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wan-Fu Hsu
- Division of Pediatric cardiology, Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsing-Yuan Li
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Betau Hwang
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Pediatric Cardiology, Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC
| | - Fei-Yi Wu
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Zen-Chung Weng
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Chieh-Mao Chuang
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Der-Shiun Wang
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Pi-Chang Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Pediatric Cardiology, Mackay Children's Hospital, Taipei, Taiwan, ROC
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Purifoy ET, Spray BJ, Riley JS, Prodhan P, Bolin EH. Effect of Trisomy 21 on Postoperative Length of Stay and Non-cardiac Surgery After Complete Repair of Tetralogy of Fallot. Pediatr Cardiol 2019; 40:1627-1632. [PMID: 31494702 DOI: 10.1007/s00246-019-02196-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022]
Abstract
Trisomy 21 (T21) is the most common chromosomal abnormality, and is frequently associated with congenital heart disease. Results of previous studies evaluating the effect of T21 on postoperative outcomes and complications following heart surgery have been mixed. Our goal was to determine if T21 is associated with higher frequency of adverse postoperative outcomes following repair of tetralogy of Fallot (TOF). A query of the Pediatric Health Information System was performed for patients who underwent complete repair of TOF from 2004 to 2015. Patients with a genetic syndrome other than T21 and tracheostomy and/or gastrostomy prior to heart surgery were excluded. Two groups were created on the basis of whether patients received a diagnostic code for T21. The adverse outcomes of interest were postoperative mortality, postoperative length of stay (LOS), postoperative gastrostomy, and postoperative tracheostomy. Univariate and Kaplan-Meier analysis were performed to evaluate outcomes. There were a total of 4790 patients; 430 (9%) patients had T21, and 4360 (91%) patients without a genetic diagnosis. There was no significant difference in mortality before discharge between those with and without T21 (2.3% vs 1.4%; p = 0.155). Patients with T21 had longer postoperative LOS (mean of 19.8 days vs 12.4 days; p < 0.001), and higher rates of postoperative gastrostomy (13.3% vs 5.3%; p < 0.02). There was no significant difference between groups for rates of postoperative tracheostomy (1.9% vs 1.2%; p = 0.276). Kaplan-Meier analysis confirmed that patients with T21 had longer postoperative LOS and greater incidence of gastrostomy.
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Affiliation(s)
- Eric T Purifoy
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA.
| | - Beverly J Spray
- Biostatistics Core, Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202-3591, USA
| | - Joe S Riley
- Biostatistics Core, Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202-3591, USA
| | - Parthak Prodhan
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Elijah H Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
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Azhar AS. Unplanned hospital readmissions following congenital heart diseases surgery. Prevalence and predictors. Saudi Med J 2019; 40:802-809. [PMID: 31423517 PMCID: PMC6718848 DOI: 10.15537/smj.2019.8.24405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate the rate of unplanned hospital readmission following surgical repair of congenital heart defects (CHD) and investigate the related causes and risk factors. METHODS A retrospective chart review of all the patients who underwent surgical repair of CHD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The study outcome consisted of any hospital admission during the 12 months following the first reparative surgery. Exclusion criteria included planned admissions. Patients' demographic and readmission data as well as the perioperative data were collected and analyzed as factors and predictors of unplanaed readmission. RESULTS After the exclusion of the deceased patients, a total of 189 patients were included. The readmission rate was 15.9% during a one-year period following surgery. There was a significant association between the probability of readmission and preoperative mechanical ventilation (MV) (p less than 0.001), intraoperative complications (p=0.025), prolonged postoperative length of stay (LOS) (p less than 0.001), early postoperative complication (p=0.007), long postoperative MV stay, and drain tube stay (p=0.011). Significant predictors of unplanned readmission included young age (1-12 months) and low weight at surgery (less than 5kg), preoperative MV, intraoperative complications, postoperative LOS ≥10 days, pediatric intensive care unit stay, MV stay, drain tube stay, infections, respiratory complication, and feeding problems. Only the preoperative MV and LOS greater than 10 days were the independent risk factors. CONCLUSION Readmission rates were similar to those reported in other studies. Future studies are warranted to investigate suitable actions to alleviate the modifiable risk factors, such as postoperative complications.
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Affiliation(s)
- Ahmad S Azhar
- Pediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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