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Ramineni A, Faateh M, Mehdizadeh-Shrifi A, Hayes D, Morales DLS. Outcomes of Concomitant Cardiac Surgical Procedures Performed During Pediatric Lung Transplantation in the United States. Lung 2024:10.1007/s00408-024-00718-x. [PMID: 38971847 DOI: 10.1007/s00408-024-00718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/11/2024] [Indexed: 07/08/2024]
Abstract
Data on concomitant cardiac surgery (CCS) performed during pediatric lung transplantation (LTx) is limited. Therefore, we conducted a multi-institutional analysis to identify the incidence and outcomes of CCS in pediatric (< 18 years) LTx recipients by merging data (2004-2023) from the United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) databases. Of the total of 596 pediatric LTx recipients, 87 (15%) underwent CCS. The majority of these cardiac surgeries were atrial septal defect (ASD) closure (90%) followed by aortic arch/descending aortic repair (3%), atrial repair (3%), ventricular septal defect closure (2%), patent ductus arteriosus ligation (2%), and tricuspid valve repair (2%). The median age at LTx was 3 years (IQR: 0-12). Pulmonary hypertension (PHT) was the predominant indication for LTx (54%). Survival to discharge was 94% and 5-years survival was 64%. Our findings indicate CCS in children undergoing LTx has acceptable outcomes.
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Affiliation(s)
- Aadhyasri Ramineni
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Muhammad Faateh
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Amir Mehdizadeh-Shrifi
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Don Hayes
- Division of Pulmonology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David L S Morales
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
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Kulshrestha K, Greenberg JW, Kennedy JT, Hogue S, Winlaw DS, Ashfaq A, Zafar F, Morales DLS. The majority of pediatric Fontan patients have excellent post-transplant survival. J Thorac Cardiovasc Surg 2024; 167:2193-2203. [PMID: 37774778 PMCID: PMC10965507 DOI: 10.1016/j.jtcvs.2023.09.044] [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: 05/05/2023] [Revised: 08/20/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Many pediatric Fontan patients require heart transplant, but this cohort is understudied given the difficulty in identifying these patients in national registries. We sought to characterize survival post-transplant in a large cohort of pediatric patients undergoing the Fontan. METHODS The United Network for Organ Sharing and Pediatric Health Information System were used to identify Fontan heart transplant recipients aged less than 18 years (n = 241) between 2005 and 2022. Decompensation was defined as the presence of extracorporeal membrane oxygenation, ventilation, hepatic/renal dysfunction, paralytics, or total parenteral nutrition at transplant. RESULTS Median age at transplant was 9 (interquartile range, 5-12) years. Median waitlist time was 107 (37-229) days. Median volume across 32 center was 8 (3-11) cases. Approximately half (n = 107, 45%) of recipients had 1A/1 initial listing status. Sixty-four patients (28%) were functionally impaired at transplant, 10 patients (4%) were ventilated, and 18 patients (8%) had ventricular assist device support. Fifty-nine patients (25%) had hepatic dysfunction, and 15 patients (6%) had renal dysfunction. Twenty-one patients (9%) were dependent on total parenteral nutrition. Median postoperative stay was 24 (14-46) days, and in-hospital mortality was 7%. Kaplan-Meier analysis showed 1- and 5-year survivals of 89% (95% CI, 85-94) and 74% (95% CI, 81-86), respectively. Kaplan-Meier of Fontan patients without decompensation (n = 154) at transplant demonstrated 1- and 5-year survivals of 93% (95% CI, 88-97) and 88% (95% CI, 82-94), respectively. In-hospital mortality was higher in decompensated patients (11% vs 4%, P = .023). Multivariable analysis showed that decompensation predicted worse post-transplant survival (hazard ratio, 2.47; 95% CI, 1.16-5.22; P = .018), whereas older age at transplant predicted superior post-transplant survival (hazard ratio, 0.89/year; 95% CI, 0.80-0.98; P = .019). CONCLUSIONS Pediatric Fontan post-transplant outcomes are promising, although early mortality remains high. For nondecompensated pediatric patients at transplant without end-organ disease (>63% of cohort), early mortality is circumvented and post-transplant survival is excellent and similar to all pediatric transplantation.
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Affiliation(s)
- Kevin Kulshrestha
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Jason W Greenberg
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - John T Kennedy
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Spencer Hogue
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David S Winlaw
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Awais Ashfaq
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Farhan Zafar
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Gholamzadeh M, Abtahi H, Safdari R. Machine learning-based techniques to improve lung transplantation outcomes and complications: a systematic review. BMC Med Res Methodol 2022; 22:331. [PMID: 36564710 PMCID: PMC9784000 DOI: 10.1186/s12874-022-01823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Machine learning has been used to develop predictive models to support clinicians in making better and more reliable decisions. The high volume of collected data in the lung transplant process makes it possible to extract hidden patterns by applying machine learning methods. Our study aims to investigate the application of machine learning methods in lung transplantation. METHOD A systematic search was conducted in five electronic databases from January 2000 to June 2022. Then, the title, abstracts, and full text of extracted articles were screened based on the PRISMA checklist. Then, eligible articles were selected according to inclusion criteria. The information regarding developed models was extracted from reviewed articles using a data extraction sheet. RESULTS Searches yielded 414 citations. Of them, 136 studies were excluded after the title and abstract screening. Finally, 16 articles were determined as eligible studies that met our inclusion criteria. The objectives of eligible articles are classified into eight main categories. The applied machine learning methods include the Support vector machine (SVM) (n = 5, 31.25%) technique, logistic regression (n = 4, 25%), Random Forests (RF) (n = 4, 25%), Bayesian network (BN) (n = 3, 18.75%), linear regression (LR) (n = 3, 18.75%), Decision Tree (DT) (n = 3, 18.75%), neural networks (n = 3, 18.75%), Markov Model (n = 1, 6.25%), KNN (n = 1, 6.25%), K-means (n = 1, 6.25%), Gradient Boosting trees (XGBoost) (n = 1, 6.25%), and Convolutional Neural Network (CNN) (n = 1, 6.25%). Most studies (n = 11) employed more than one machine learning technique or combination of different techniques to make their models. The data obtained from pulmonary function tests were the most used as input variables in predictive model development. Most studies (n = 10) used only post-transplant patient information to develop their models. Also, UNOS was recognized as the most desirable data source in the reviewed articles. In most cases, clinicians succeeded to predict acute diseases incidence after lung transplantation (n = 4) or estimate survival rate (n = 4) by developing machine learning models. CONCLUSION The outcomes of these developed prediction models could aid clinicians to make better and more reliable decisions by extracting new knowledge from the huge volume of lung transplantation data.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical Care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran.
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Greenberg JW, Kulshrestha K, Dani A, Winlaw DS, Lehenbauer DG, Chin C, Lorts A, Gist KM, Zafar F, Morales DLS. Not all durations of preheart transplant mechanical ventilation portend inferior post-transplant survival in children. Pediatr Transplant 2022; 27:e14433. [PMID: 36345131 DOI: 10.1111/petr.14433] [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: 09/06/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mechanical ventilation prior to pediatric heart transplantation predicts inferior post-transplant survival, but the impact of ventilation duration on survival is unclear. METHODS Data from the United Network for Organ Sharing and Pediatric Health Information System were used to identify pediatric (<18 years) heart transplant recipients from 2003 to 2020. Patients ventilated pretransplant were first compared to no ventilation, then ventilation durations were compared across quartiles of ventilation (≤1 week, 8 days-5 weeks, >5 weeks). RESULTS At transplant, 11% (511/4506) of patients required ventilation. Ventilated patients were younger, had more congenital heart disease, more urgent listing-status, and greater rates of nephropathy, TPN-dependence, and inotrope and ECMO requirements (p < .001 for all). Post-transplant, previously ventilated patients experienced longer ventilation durations, ICU and hospital stays, and inferior survival (all p < .001). Hospital outcomes and survival worsened with longer pretransplant ventilation. One-year and overall survival were similar between the no-ventilation and ≤1 week groups (p = .703 & p = .433, respectively) but were significantly worse for ventilation durations >1 week (p < .001). On multivariable analysis, ventilation ≤1 week did not predict mortality (HR 0.98 [95% CI 0.85-1.43]), whereas ventilation >1 week did (HR: 1.18 [1.01-1.39]). CONCLUSIONS Longer pretransplant ventilation portends worse outcomes, although only ventilation >1 week predicts mortality. These findings can inform pretransplant prognostication.
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Affiliation(s)
- Jason W Greenberg
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kevin Kulshrestha
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alia Dani
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David S Winlaw
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David G Lehenbauer
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Clifford Chin
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katja M Gist
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Center Variation in Indication and Short-Term Outcomes after Pediatric Heart Transplantation: Analysis of a Merged United Network for Organ Sharing - Pediatric Health Information System Cohort. Pediatr Cardiol 2022; 43:636-644. [PMID: 34779880 DOI: 10.1007/s00246-021-02768-x] [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: 09/22/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
The relationship between center-specific variation in indication for pediatric heart transplantation and short-term outcomes after heart transplantation is not well described. We used merged patient- and hospital-level data from the United Network for Organ Sharing and the Pediatric Health Information Systems to analyze outcomes according to transplant indication for a cohort of children (≤ 21 years old) who underwent heart transplantation between 2004 and 2015. Outcomes included 30-day mortality, transplant hospital admission mortality, and hospital length of stay, with multivariable adjustment performed according to patient and center characteristics. The merged cohort reflected 2169 heart transplants at 20 U.S. centers. The median number of transplants annually at each center was 11.6, but ranged from 3.5 to 22.6 transplants/year. Congenital heart disease was the indication in the plurality of cases (49.2%), with cardiomyopathy (46%) and myocarditis (4.8%) accounting for the remainder. There was significant center-to-center variability in congenital heart disease as the principal indication, ranging from 15% to 66% (P < 0.0001). After adjustment, neither center volume nor proportion of indications for transplantation were associated with 30-day or transplant hospital admission mortality. In this large, merged pediatric cohort, variation was observed at center level in annual transplant volume and prevalence of indications for heart transplantation. Despite this variability, center volume and proportion of indications represented at a given center did not appear to impact short-term outcomes.
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Kanneganti M, Xu Y, Huang YS, Kitt E, Fisher BT, Abt PL, Rand EB, Schaubel DE, Bittermann T. Center Variability in Acute Rejection and Biliary Complications After Pediatric Liver Transplantation. Liver Transpl 2022; 28:454-465. [PMID: 34365719 PMCID: PMC8821725 DOI: 10.1002/lt.26259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/09/2021] [Accepted: 07/28/2021] [Indexed: 01/13/2023]
Abstract
Transplant center performance and practice variation for pediatric post-liver transplantation (LT) outcomes other than survival are understudied. This was a retrospective cohort study of pediatric LT recipients who received transplants between January 1, 2006, and May 31, 2017, using United Network for Organ Sharing (UNOS) data that were merged with the Pediatric Health Information System database. Center effects for the acute rejection rate at 1 year after LT (AR1) using UNOS coding and the biliary complication rate at 1 year after LT (BC1) using inpatient billing claims data were estimated by center-specific rescaled odds ratios that accounted for potential differences in recipient and donor characteristics. There were 2216 pediatric LT recipients at 24 freestanding children's hospitals in the United States during the study period. The median unadjusted center rate of AR1 was 36.92% (interquartile range [IQR], 22.36%-44.52%), whereas that of BC1 was 32.29% (IQR, 26.14%-40.44%). Accounting for recipient case mix and donor factors, 5/24 centers performed better than expected with regard to AR1, whereas 3/24 centers performed worse than expected. There was less heterogeneity across the center effects for BC1 than for AR1. There was no relationship observed between the center effects for AR1 or BC1 and center volume. Beyond recipient and allograft factors, differences in transplant center management are an important driver of center AR1 performance, and less so of BC1 performance. Further research is needed to identify the sources of variability so as to implement the most effective solutions to broadly enhance outcomes for pediatric LT recipients.
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Affiliation(s)
- Mounika Kanneganti
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yuwen Xu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Yuan-Shung Huang
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Eimear Kitt
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian T Fisher
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA,Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Peter L Abt
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth B Rand
- Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Douglas E Schaubel
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Therese Bittermann
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA,Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA,Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
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Thangappan K, Haney LC, Riggs K, Chen S, Mehegan M, VanderPluym C, Woods R, LaPar D, Lorts A, Zafar F, Morales DLS. Children who stroke on VAD support: when is it safe to transplant and what are their outcomes? Artif Organs 2022; 46:1389-1398. [PMID: 35132634 DOI: 10.1111/aor.14194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ventricular assist devices (VADs) increase waitlist survival, yet the risk of stroke remains notable. The purpose of this study was to analyze how strokes on VAD support impact post-transplant (post-Tx) outcomes in children. METHODS 520 pediatric (<18 yo) heart transplant candidates listed from January 2011 to April 2018 with a VAD implant date were matched between the United Network of Organ Sharing and Pediatric Health Information System databases. Patients were divided into pre-Tx Stroke and No Stroke cohorts. RESULTS 81% of the 520 patients were transplanted. 28% (n=146) had a pre-Tx Stroke. 59% (n=89) of the Stroke patients were transplanted at a median of 57 (IQR 17-102) days from stroke. Significantly more No Stroke cohort (90%) were transplanted (p<0.001). There was no difference in post-Tx survival between the Stroke and No Stroke cohorts (p=0.440). Time between stroke and transplant for patients who died within one year of transplant was 32.0 days (median) compared to 60.5 days for those alive > 1year (p=0.18). Regarding patients in whom time from stroke to transplant was more than 60 days, one-year survival of Stroke vs. No Stroke patients was 96% vs. 95% (p=0.811), respectively. CONCLUSION Patients with stroke during VAD support, once transplanted, enjoy similar survival compared to No Stroke patients. We hypothesize that allowing Stroke patients more time to recover could improve post-Tx outcomes. Unfortunately, the ideal duration of time between stroke and safe transplantation could not be determined and will require more detailed and larger studies in the future.
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Affiliation(s)
- Karthik Thangappan
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Li Cai Haney
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kyle Riggs
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Mary Mehegan
- Division of Cardiothoracic Surgery, St. Louis Children's Hospital, Saint Louis, MO, USA
| | | | - Ronald Woods
- Division of Congenital Heart Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Damien LaPar
- Department of Pediatric Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Angela Lorts
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Farhan Zafar
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Sehgal M, Amritphale A, Vadayla S, Mulekar M, Batra M, Amritphale N, Batten LA, Vidal R. Demographics and Risk Factors of Pediatric Pulmonary Hypertension Readmissions. Cureus 2021; 13:e18994. [PMID: 34853737 PMCID: PMC8608354 DOI: 10.7759/cureus.18994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary hypertension (PH) leads to significant morbidity and mortality in pediatric patients and increases the readmission rates for hospitalizations. This study evaluates the risk factors and comorbidities associated with an increase in 30-day readmissions among pediatric PH patients. METHODS National Readmission Database (NRD) 2017 was searched for patients less than 18 years of age who were diagnosed with PH based on the International Classification of Diseases, 10th Revision (ICD-10). Statistical Package for the Social Sciences (SPSS) software v25.0 (IBM Corp., Armonk, NY) was used for statistical analysis. RESULTS Of 5.52 million pediatric encounters, 10,501 patients met the selection criteria. The 30-day readmission rate of 14.43% (p < 0.001) was higher than hospitalizations from other causes {Odds Ratio (OR) 4.02 (3.84-4.20), p < 0.001}. The comorbidities of sepsis {OR 0.75 (0.64-0.89), p < 0.02} and respiratory infections {OR 0.75 (0.67-0.85), p < 0.001} were observed to be associated with lower 30-day readmissions. Patients who required invasive mechanical ventilation via endotracheal tube {OR 1.66 (1.4-1.96), p < 0.001} or tracheostomy tube {OR 1.35 (1.15-1.6), p < 0.001} had increased unplanned readmissions. Patients with higher severity of illness based on All Patients Refined Diagnosis Related Groups (APR-DRG) were more likely to get readmitted {OR 7.66 (3.13-18.76), p < 0.001}. CONCLUSION PH was associated with increased readmission rates compared to the other pediatric diagnoses, but the readmission rate in this study was lower than one previous pediatric study. Invasive mechanical ventilation, Medicaid insurance, higher severity of illness, and female gender were associated with a higher likelihood of readmission within 30 days.
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Affiliation(s)
- Mukul Sehgal
- Pediatric Critical Care, University of South Alabama College of Medicine, Mobile, USA
| | - Amod Amritphale
- Cardiology, University of South Alabama College of Medicine, Mobile, USA
| | - Shashank Vadayla
- Computational Analysis and Modelling, Louisiana Tech University, Ruston, USA
| | - Madhuri Mulekar
- Mathematics and Statistics, University of South Alabama, Mobile, USA
| | - Mansi Batra
- Pediatrics, University of South Alabama College of Medicine, Mobile, USA
| | - Nupur Amritphale
- Pediatrics, University of South Alabama College of Medicine, Mobile, USA
| | - Lynn A Batten
- Pediatric Cardiology, University of South Alabama College of Medicine, Mobile, USA
| | - Rosa Vidal
- Pediatric Critical Care, University of South Alabama College of Medicine, Mobile, USA
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Riggs KW, Broderick JT, Price N, Chin C, Zafar F, Morales DLS. Transplantation for Congenital Heart Disease: Focus on the Impact of Functionally Univentricular Versus Biventricular Circulation. World J Pediatr Congenit Heart Surg 2021; 12:352-359. [PMID: 33942695 DOI: 10.1177/2150135121990650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Varying single center data exist regarding the posttransplant outcomes of patients with single ventricle circulation, particularly following the Fontan operation. We sought to better elucidate these results in patients with congenital heart disease (CHD) through combining two national databases. METHODS The United Network for Organ Sharing (UNOS) transplantation database was merged with the Pediatric Health Information System (PHIS), an administrative database with 71% of UNOS patients matched. Patients undergoing transplantation at a PHIS hospital from 2006 to 2017 were categorized as single ventricle or biventricular strategy based on their diagnoses and procedures in 90% of patients. When known, single ventricle patients were further analyzed by their palliative stage post-Glenn or post-Fontan (known in 31%). RESULTS A total of 1,517 CHD transplantations were identified, 67% with single ventricle strategy (1,016). Single ventricle, biventricular, and indeterminate patients had similar survival (log-rank P > .1). Risk factors for mortality in patients with CHD were extracorporeal membrane oxygenation (ECMO) support at transplant (hazard: 2.27), ABO blood type incompatibility (hazard: 1.61), African American recipient (hazard 1.42), and liver dysfunction (hazard 1.29). A total of 130 confirmed Fontan and 185 confirmed bidirectional Glenn patients underwent transplantation, each with survival equivalent to biventricular patients (log-rank P > .500). For Fontan patients, renal dysfunction (hazard: 5.40) and transplant <1 year after Fontan (hazard 2.82) were found to be associated with mortality. CONCLUSIONS Single ventricle patients, as a group, experience similar outcomes as biventricular patients with CHD undergoing transplantation, and this extends to Fontan patients. Risk factors for mortality correlate with end-organ dysfunction as well as race and ABO blood type incompatibility in the CHD population.
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Affiliation(s)
- Kyle W Riggs
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - John T Broderick
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Nina Price
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Clifford Chin
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Farhan Zafar
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - David L S Morales
- Heart Institute, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
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Lazarini LDF, Ohler L, Schirmer J, Roza BDA. Validation of the american quality assessment model and performance improvement to the brazilian transplant. Rev Lat Am Enfermagem 2020; 28:e3252. [PMID: 32074211 PMCID: PMC7021480 DOI: 10.1590/1518-8345.3249.3252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/01/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: To validate the quality assessment and performance improvement instrument of US
transplant programs to the Brazilian reality. Method: Methodological study developed for semantic validation and cultural adaptation of
the Quality assessment and Performance Improvement instrument in the following
steps: 1) translation; 2) synthesis; 3) back translation; 4) review by expert
committee; 5) pretest and 6) content validation. To evaluate the agreement between
the five judges, the Kappa coefficient was used and for content validation, the
content validation index. Results: Kappa coefficient showed the agreement of the judges for semantic, idiomatic,
cultural and conceptual equivalences. Content validation index values for
relevance and item sequence of at least 0.80 for all blocks. Conclusion: The instrument of Quality Evaluation and Performance Improvement of
Transplantation Programs proved to be valid and reliable. This instrument will
contribute to the development of quality assurance programs for transplant teams
in Brazil.
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Affiliation(s)
| | - Linda Ohler
- New York University, Langone Transplant Institute, New York, NY, United States of America
| | - Janine Schirmer
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
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Godown J, Gaies M, Wilkinson JD. Leveraging big data to advance knowledge in pediatric heart failure and heart transplantation. Transl Pediatr 2019; 8:342-348. [PMID: 31728327 PMCID: PMC6825960 DOI: 10.21037/tp.2019.07.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/11/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN, USA
| | - Michael Gaies
- Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James D. Wilkinson
- Department of Pediatrics, Monroe Carell Jr. Children’s Hospital, Nashville, TN, USA
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12
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Godown J, Hall M, Thompson B, Thurm C, Jabs K, Gillis LA, Hafberg ET, Alexopoulos S, Karp SJ, Soslow JH. Expanding analytic possibilities in pediatric solid organ transplantation through linkage of administrative and clinical registry databases. Pediatr Transplant 2019; 23:e13379. [PMID: 30793448 PMCID: PMC6853795 DOI: 10.1111/petr.13379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/28/2018] [Accepted: 01/21/2019] [Indexed: 12/18/2022]
Abstract
Database linkage is a common strategy to expand analytic possibilities. Our group recently completed a linkage between the SRTR and PHIS databases for pediatric heart transplant recipients. The aim of this project was to expand the linkage between SRTR and PHIS to include liver, kidney, lung, heart-lung, and small bowel transplants. All patients (<21 years) who underwent liver, kidney, lung, heart-lung, or small bowel transplant were identified from the PHIS database using APR-DRG codes (2002-2018). Linkage was performed in a stepwise approach using indirect identifiers. Hospital costs were estimated based on hospital charges and cost-to-charge ratios, inflated to 2018 dollars and described by transplant type. A total of 14 061 patients overlapped between databases. Of these, 13 388 (95.2%) were uniquely linked. Linkage success ranged from 92.6% to 97.8% by organ system. A total of 12 940 (92%) patients had complete cost data. Hospitalization costs were greatest for patients undergoing small bowel transplantation with a median cost of $734 454 (IQR $336 174 - $1 504 167), followed by heart $565 386 (IQR $352 813 - $999 216), heart-lung $471 573 (IQR $328 523 - 992 438), lung $303 536 (IQR $215 383 - $612 749), liver $200 448 (IQR $130 880 - $357 897), and kidney transplant $94 796 (IQR $73 157 -$131 040). We report a robust linkage between the SRTR and PHIS databases, providing an invaluable tool to assess resource utilization in solid organ transplant recipients. Our analysis provides contemporary cost data for pediatric solid organ transplantation from the largest US sample reported to date. It also provides a platform for expanded analyses in the pediatric transplant population.
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Affiliation(s)
- Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Bryn Thompson
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - Cary Thurm
- Children’s Hospital Association, Lenexa, KS
| | - Kathy Jabs
- Pediatric Nephrology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Lynette A. Gillis
- Pediatric Gastroenterology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Einar T. Hafberg
- Pediatric Gastroenterology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | | | - Seth J. Karp
- Department of Surgery, Vanderbilt University Hospital, Nashville, TN
| | - Jonathan H. Soslow
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
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Mortality, Resource Utilization, and Inpatient Costs Vary Among Pediatric Heart Transplant Indications: A Merged Data Set Analysis From the United Network for Organ Sharing and Pediatric Health Information Systems Databases. J Card Fail 2019; 25:27-35. [DOI: 10.1016/j.cardfail.2018.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022]
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