Factors Associated with Inability to Discharge After Stage 1 Palliation for Single Ventricle Heart Disease: An Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database

Andrea Otero Luna, Pierce Kuhnell, Sharyl Wooton, Stephanie S. Handler, Gail Wright, James Hammel, James S. Tweddell, Titus Chan

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalPediatric cardiology
DOIs
StateAccepted/In press - 2022

Keywords

  • Hospital discharge
  • Norwood
  • Single ventricle
  • Stage 1 palliation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Factors Associated with Inability to Discharge After Stage 1 Palliation for Single Ventricle Heart Disease: An Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database'. Together they form a unique fingerprint.

Cite this