TY - JOUR
T1 - Factors Associated with Inability to Discharge After Stage 1 Palliation for Single Ventricle Heart Disease
T2 - An Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database
AU - Luna, Andrea Otero
AU - Kuhnell, Pierce
AU - Wooton, Sharyl
AU - Handler, Stephanie S.
AU - Wright, Gail
AU - Hammel, James
AU - Tweddell, James S.
AU - Chan, Titus
N1 - Funding Information:
This research received no funding from any source.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/8
Y1 - 2022/8
N2 - Patient-level characteristics associated with survival for single ventricle heart disease following initial staged palliation have been described. However, the impact of peri-operative events on hospital discharge has not been examined. To characterize patient-level characteristics and peri-operative events that were associated with inability to be discharged after Stage 1 palliation (S1P). Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Dataset including patients who underwent a S1P procedure between 2016 and 2019 (Norwood or Hybrid Stage 1 procedure). We examined patient-level characteristics and peri-operative events as possible predictors of inability to discharge after S1P. We constructed multivariate logistic regression models examining post-S1P discharge and in-hospital mortality, adjusting for covariates. 843 patients underwent a S1P and 717 (85%) patients were discharged home or remained inpatient until Stage 2 for social but not medical concerns. Moderate or greater pre-operative atrioventricular valve regurgitation (odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8–12), presence of high-risk pre-operative adverse events (OR 1.5, 95%CI 1.0–2.3), peri-operative events: temporary dialysis (OR 5.4, 95%CI 1.5–18.9), cardiac catheterization or cardiac surgery (OR 2.9, 95%CI 1.8–4.6), sepsis (OR 2.7, 95%CI 1.2–6.2), junctional tachycardia (OR 2.6, 95%CI 1.0–6.3), necrotizing enterocolitis (OR 2.6, 95%CI 1.3–5.2), ECMO (OR 2.5, 95%CI 1.4–4.3), neurological injury (OR 2.1, 95%CI 1.1–4.1), and re-intubation (OR 1.8, 95%CI 1.1–2.9) were associated with inability to discharge after Stage 1. Cardiac anatomical factors, pre-operative adverse events, post-operative re-intubation, post-operative ECMO, infectious complications, and unplanned catheter or surgical re-interventions were associated with inability to discharge after S1P. These findings suggest that quality improvement efforts aimed at reducing these peri-operative events may improve Stage 1 survival and likelihood of discharge.
AB - Patient-level characteristics associated with survival for single ventricle heart disease following initial staged palliation have been described. However, the impact of peri-operative events on hospital discharge has not been examined. To characterize patient-level characteristics and peri-operative events that were associated with inability to be discharged after Stage 1 palliation (S1P). Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Dataset including patients who underwent a S1P procedure between 2016 and 2019 (Norwood or Hybrid Stage 1 procedure). We examined patient-level characteristics and peri-operative events as possible predictors of inability to discharge after S1P. We constructed multivariate logistic regression models examining post-S1P discharge and in-hospital mortality, adjusting for covariates. 843 patients underwent a S1P and 717 (85%) patients were discharged home or remained inpatient until Stage 2 for social but not medical concerns. Moderate or greater pre-operative atrioventricular valve regurgitation (odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8–12), presence of high-risk pre-operative adverse events (OR 1.5, 95%CI 1.0–2.3), peri-operative events: temporary dialysis (OR 5.4, 95%CI 1.5–18.9), cardiac catheterization or cardiac surgery (OR 2.9, 95%CI 1.8–4.6), sepsis (OR 2.7, 95%CI 1.2–6.2), junctional tachycardia (OR 2.6, 95%CI 1.0–6.3), necrotizing enterocolitis (OR 2.6, 95%CI 1.3–5.2), ECMO (OR 2.5, 95%CI 1.4–4.3), neurological injury (OR 2.1, 95%CI 1.1–4.1), and re-intubation (OR 1.8, 95%CI 1.1–2.9) were associated with inability to discharge after Stage 1. Cardiac anatomical factors, pre-operative adverse events, post-operative re-intubation, post-operative ECMO, infectious complications, and unplanned catheter or surgical re-interventions were associated with inability to discharge after S1P. These findings suggest that quality improvement efforts aimed at reducing these peri-operative events may improve Stage 1 survival and likelihood of discharge.
KW - Hospital discharge
KW - Norwood
KW - Single ventricle
KW - Stage 1 palliation
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U2 - 10.1007/s00246-022-02852-w
DO - 10.1007/s00246-022-02852-w
M3 - Article
C2 - 35243519
AN - SCOPUS:85125525020
SN - 0172-0643
VL - 43
SP - 1298
EP - 1310
JO - Pediatric cardiology
JF - Pediatric cardiology
IS - 6
ER -