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Vashist S, Dudeck BS, Sherfy B, Rosenthal GL, Chaves AH. Neighborhood socioeconomic status and length of stay after congenital heart disease surgery. Front Pediatr 2023; 11:1167064. [PMID: 37534195 PMCID: PMC10390779 DOI: 10.3389/fped.2023.1167064] [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: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 08/04/2023] Open
Abstract
Background and Objectives Socioeconomic factors are associated with health outcomes and can affect postoperative length of stay after congenital heart disease (CHD) surgery. The hypothesis of this study is that patients from neighborhoods with a disadvantaged socioeconomic status (SES) have a prolonged length of hospital stay after CHD surgery. Methods Pre- and postoperative data were collected on patients who underwent CHD surgery at the University of Maryland Medical Center between 2011 and 2019. A neighborhood SES score was calculated for each patient using data from the United States Census Bureau and patients were grouped by high vs. low SES neighborhoods. The difference of patient length of stay (LOS) from the Society for Thoracic Surgeons median LOS for that surgery was the primary outcome measure. Linear regression was performed to examine the association between the difference from the median LOS and SES, as well as other third variables. Results The difference from the median LOS was -4.8 vs. -2.2 days in high vs. low SES groups (p = 0.003). SES category was a significant predictor of LOS in unadjusted and adjusted regression analyses. There was a significant interaction between Norwood operation and SES-patients with a low neighborhood SES who underwent Norwood operation had a longer LOS, but there was no difference in LOS by SES in patients who underwent other operations. Conclusions Neighborhood SES is a significant predictor of the LOS after congenital heart disease surgery. This effect was seen primarily in patients undergoing Norwood operation.
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Affiliation(s)
- Sudhir Vashist
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Brandon S. Dudeck
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Beth Sherfy
- University of Maryland Medical Center, Baltimore, MD, United States
| | - Geoffrey L. Rosenthal
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Alicia H. Chaves
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
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Post-operative course of pulmonary artery pressure after complete atrioventricular canal defect repair. Cardiol Young 2022; 32:398-404. [PMID: 34114532 DOI: 10.1017/s1047951121002201] [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: 11/07/2022]
Abstract
UNLABELLED Complete atrioventricular canal defect is a CHD associated with intra-cardiac shunting of blood, which can lead to irreversible changes in pulmonary vascular resistance and pulmonary artery hypertension if unrepaired. Patients with Trisomy 21 are at risk for early development of pulmonary artery hypertension if left uncorrected.1,2. OBJECTIVES The purpose of this study is to describe the evolution of pulmonary artery hypertension after repair of complete atrioventricular canal defect and to determine the time to normalisation of pulmonary artery pressure in both patients with and without Trisomy 21. METHODS This is a single centre, retrospective analysis of patients with complete atrioventricular canal defect admitted for surgical repair at the University of Maryland Medical Center from 2005 to 2015. T-test or Mann-Whitney test and Chi-Square or Fisher's exact tests were used to compare the two groups (patients with Trisomy 21 and those without). Repeated measures of analysis of variance and serial measurement analysis were performed. RESULTS Twenty-nine patients meeting the inclusion criteria underwent repair of complete atrioventricular defects during the study period. The right ventricular pressure estimate remained elevated over time and did not show a significant difference between the two groups. Right ventricular to systolic blood pressure ratios for all patients remained > 0.5 over the time periods assessed. CONCLUSIONS Our study suggests that in patients with complete atrioventricular canal defects, the right ventricular pressure remains elevated and does not normalise on echocardiograms performed up to one year after surgery, suggesting a sustained elevation in pulmonary vascular resistance.
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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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Wilmanns JC, Pandey R, Hon O, Chandran A, Schilling JM, Forte E, Wu Q, Cagnone G, Bais P, Philip V, Coleman D, Kocalis H, Archer SK, Pearson JT, Ramialison M, Heineke J, Patel HH, Rosenthal NA, Furtado MB, Costa MW. Metformin intervention prevents cardiac dysfunction in a murine model of adult congenital heart disease. Mol Metab 2019; 20:102-114. [PMID: 30482476 PMCID: PMC6358551 DOI: 10.1016/j.molmet.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Congenital heart disease (CHD) is the most frequent birth defect worldwide. The number of adult patients with CHD, now referred to as ACHD, is increasing with improved surgical and treatment interventions. However the mechanisms whereby ACHD predisposes patients to heart dysfunction are still unclear. ACHD is strongly associated with metabolic syndrome, but how ACHD interacts with poor modern lifestyle choices and other comorbidities, such as hypertension, obesity, and diabetes, is mostly unknown. METHODS We used a newly characterized mouse genetic model of ACHD to investigate the consequences and the mechanisms associated with combined obesity and ACHD predisposition. Metformin intervention was used to further evaluate potential therapeutic amelioration of cardiac dysfunction in this model. RESULTS ACHD mice placed under metabolic stress (high fat diet) displayed decreased left ventricular ejection fraction. Comprehensive physiological, biochemical, and molecular analysis showed that ACHD hearts exhibited early changes in energy metabolism with increased glucose dependence as main cardiac energy source. These changes preceded cardiac dysfunction mediated by exposure to high fat diet and were associated with increased disease severity. Restoration of metabolic balance by metformin administration prevented the development of heart dysfunction in ACHD predisposed mice. CONCLUSIONS This study reveals that early metabolic impairment reinforces heart dysfunction in ACHD predisposed individuals and diet or pharmacological interventions can be used to modulate heart function and attenuate heart failure. Our study suggests that interactions between genetic and metabolic disturbances ultimately lead to the clinical presentation of heart failure in patients with ACHD. Early manipulation of energy metabolism may be an important avenue for intervention in ACHD patients to prevent or delay onset of heart failure and secondary comorbidities. These interactions raise the prospect for a translational reassessment of ACHD presentation in the clinic.
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Affiliation(s)
- Julia C Wilmanns
- Australian Regenerative Medicine Institute, Monash University, Australia; Department of Cardiology and Angiology, Experimental Cardiology, Hannover Medical School, Germany
| | | | | | - Anjana Chandran
- Australian Regenerative Medicine Institute, Monash University, Australia
| | - Jan M Schilling
- VA San Diego Healthcare System and Department of Anesthesiology, University of California San Diego, USA
| | | | - Qizhu Wu
- Monash Biomedical Imaging, Monash University, Australia
| | - Gael Cagnone
- Department of Pharmacology, Research Center of CHU Sainte-Justine, Canada
| | | | | | | | | | - Stuart K Archer
- Monash Bioinformatics Platform, Monash University, Australia; Biomedicine Discovery Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - James T Pearson
- Monash Biomedical Imaging, Monash University, Australia; Department of Physiology, Monash University, Australia; National Cerebral & Cardiovascular Center, Suita 565-8565, Japan
| | - Mirana Ramialison
- Australian Regenerative Medicine Institute, Monash University, Australia; Systems Biology Institute, Australia
| | - Joerg Heineke
- Department of Cardiology and Angiology, Experimental Cardiology, Hannover Medical School, Germany
| | - Hemal H Patel
- VA San Diego Healthcare System and Department of Anesthesiology, University of California San Diego, USA
| | - Nadia A Rosenthal
- The Jackson Laboratory, USA; Australian Regenerative Medicine Institute, Monash University, Australia; National Heart and Lung Institute, Imperial College London, W12 0NN, UK
| | - Milena B Furtado
- The Jackson Laboratory, USA; Australian Regenerative Medicine Institute, Monash University, Australia
| | - Mauro W Costa
- The Jackson Laboratory, USA; Australian Regenerative Medicine Institute, Monash University, Australia.
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Self-Care in Congenital Heart Disease Patients. CONGENIT HEART DIS 2019. [DOI: 10.1007/978-3-319-78423-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Xiang L, Su Z, Liu Y, Zhang X, Li S, Hu S, Zhang H. Effect of family socioeconomic status on the prognosis of complex congenital heart disease in children: an observational cohort study from China. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:430-439. [DOI: 10.1016/s2352-4642(18)30100-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/16/2022]
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Deschepper M, Vermeir P, Vogelaers D, Devulder J, Eeckloo K. Is pain at discharge a risk factor for unplanned hospital readmission? Acta Clin Belg 2017; 72:95-102. [PMID: 28229625 DOI: 10.1080/17843286.2017.1293311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Unplanned readmissions are associated with a high cost to health insurances and the incidence of preventable readmissions could be considered as a quality indicator for the initial hospital admission. We aimed to assess the predictive value for unplanned readmission of higher pain scores at discharge of the initial admission as well as of other pain and demographic characteristics. The documentation of significant associations would provide further support for a structured pain management policy. METHODS A retrospective analysis of a large single university hospital data-set of 33.122 admissions within a 13-month period allowed for the assessment of the predictive relationship of pain toward unplanned readmission at 7 and at 30 days after discharge through logistic regression, and of other characteristics through linear regression. RESULTS Pain scores at discharge of the initial admission were not significantly different (p > 0.05) with or without unplanned readmission and hence have no predictive value on the individual patient level. The prediction of the number of patients for each group, for example the number of patients that will be readmitted (size of the group), shows significance for pain at the moment of discharge (p_initial = 0.000), pain medication (p = 0.0044), and age (p = 0.0017). Pathology (p = 0.6151) and gender (p = 0.7029) have no significant predictive value. CONCLUSION Pain as dichotomous variable upon discharge cannot be used as single risk predictor for unplanned readmission. However, the pain score at discharge in combination with the use of pain medication and age is a risk factor for the number of short-term unplanned readmissions.
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Affiliation(s)
- Mieke Deschepper
- Ghent University Hospital, (Strategic) Policy Cell, Ghent, Belgium
| | - Peter Vermeir
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Jacques Devulder
- Ghent University Hospital, Centre Multidisciplinary Pain, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Anaesthesiology and Perioperative Medicine, Ghent University, Ghent, Belgium
| | - Kristof Eeckloo
- Ghent University Hospital, (Strategic) Policy Cell, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
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Mertens LL. Use of Hospital Resources for Patients With Congenital Heart Disease in Canada. Can J Cardiol 2016; 32:941.e1-2. [DOI: 10.1016/j.cjca.2016.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 10/22/2022] Open
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