Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

Abstract Introduction: Children with congenital heart disease and cardiomyopathy are a unique patient population. Different therapies continue to be introduced with large practice variability and questionable outcomes. The purpose of this study is to determine the impact of various medications on intensive care unit length of stay, total length of stay, billed charges, and mortality for admissions with congenital heart disease and cardiomyopathy. Materials and methods: We identified admissions of paediatric patients with cardiomyopathy using the Pediatric Health Information System database. The admissions were then separated into two groups: those with and without inpatient mortality. Univariate analyses were conducted between the groups and the significant variables were entered as independent variables into the regression analyses. Results: A total of 10,376 admissions were included these analyses. Of these, 904 (8.7%) experienced mortality. Comparing patients who experienced mortality with those who did not, there was increased rate of acute kidney injury with an odds ratio (OR) of 5.0 [95% confidence interval (CI) 4.3 to 5.8, p < 0.01], cardiac arrest with an OR 7.5 (95% CI 6.3 to 9.0, p < 0.01), and heart transplant with an OR 0.3 (95% CI 0.2 to 0.4, p < 0.01). The medical interventions with benefit for all endpoints after multivariate regression analyses in this cohort are methylprednisolone, captopril, enalapril, furosemide, and amlodipine. Conclusions: Diuretics, steroids, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta blockers all appear to offer beneficial effects in paediatric cardiomyopathy admission outcomes. Specific agents within each group have varying effects.

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Risk Factors for Seizures and Epilepsy in Children With Congenital Heart Disease

Journal of Child Neurology ◽

10.1177/0883073820904912 ◽

2020 ◽

Vol 35 (7) ◽

pp. 442-447 ◽

Cited By ~ 1

Author(s):

Suman Ghosh ◽

Joseph Philip ◽

Nikita Patel ◽

Jennifer Munoz-Pareja ◽

Dalia Lopez-Colon ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Birth Weight ◽

Brain Injury ◽

High Risk ◽

Length Of Stay ◽

Potential Risk ◽

Congenital Heart ◽

Potential Risk Factors

Objectives: To identify potential risk factors for pre- and postoperative seizures and epilepsy in children with congenital heart disease. Methods: Retrospective cohort study of neonates and infants <3 months of age with congenital heart disease who underwent cardiopulmonary bypass from November 24, 2006, until June 1, 2015. Children with seizures were classified based on time of occurrence into early preoperative, early postoperative, and late postoperative. Children with recurring seizures 30 days after cardiac surgery met criteria for epilepsy. Results: 247 patients completed follow-up; 2.4% had seizures early preoperation and 1.6% early postoperation. Late postoperative epilepsy occurred in 5.3% of the cohort. The majority of seizures in the late postoperative epilepsy group started after 1 year of age (mean 1.53 years, range = 0.18-4.7 years). One of the 13 patients with epilepsy had a seizure during their intensive care unit hospitalization. Potential risk factors for seizures included brain injury ( P < .001), high-risk surgery (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score ≥3, P = .024), and low birth weight ( P < .04). Infants with stroke were more likely to develop epilepsy ( P = .04). Presence of seizures was associated with increased length of stay ( P < .001). Conclusions: Our study suggests an association between children with congenital heart disease diagnosed with stroke in the neonatal/infancy period and the development of epilepsy. These children may not have prior early pre- and postoperative seizures. Risk factors for seizures include brain injury, high-risk surgery, and lower birth weight. Seizures were associated with an increased length of stay but did not necessarily lead to subsequent epilepsy.

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Abstract 19082: Cardiac Events and Mortality During Admissions for Delivery in Women with Congenital Heart Disease

Circulation ◽

10.1161/circ.130.suppl_2.19082 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Robert M Hayward ◽

Elyse Foster ◽

Zian H Tseng

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Cardiac Arrest ◽

Heart Disease ◽

Length Of Stay ◽

Hospital Mortality ◽

Congenital Heart ◽

Cardiac Events ◽

Live Births ◽

History Of

Background: Labor, delivery, and the postpartum period are a time of increased arrhythmia and congestive heart failure (CHF) incidence. With improvements in the treatment of congenital heart disease (CHD), more women are reaching childbearing age and may be at increased risk for cardiac events and mortality during pregnancy and delivery. Methods: The Healthcare Cost and Utilization Project was used to identify admissions for vaginal and cesarean delivery in California hospitals between 1/1/2005 and 12/31/2011. We compared length of stay, in-hospital mortality, incident CHF, cardiac arrest, and incident arrhythmias for women without CHD to women with non-complex CHD (NC-CHD) and complex CHD (C-CHD). Results: We identified 2,720,980 deliveries resulting in 2,770,382 live births (74% of live births in the state over this period), which included 3,218 women with NC-CHD and 248 women with C-CHD. History of CHF was more common in women with CHD (8.1% for C-CHD, 2.6% for NC-CHD, and 0.08% for women without CHD, p<0.00005 for NC-CHD compared to no CHD and for C-CHD compared to no CHD). Those with CHD were more likely to undergo cesarean section (Table 1). Length of stay was significantly longer in women with CHD (2.6 ± 2.3 days for women without CHD, 3.4 ± 10.2 days for women with NC-CHD and 5.0 ± 13.3 days for women with C-CHD). In-hospital mortality was not significantly higher in women with CHD (Table 1). Incident heart failure, arrhythmias, and cardiac arrest were uncommon in all groups (Table 1). Conclusions: In this study of 2.7 million women admitted to California hospitals for delivery, women with CHD were more likely to undergo cesarean section and had longer length of stay. Despite more frequent history of CHF in women with CHD, incident CHF and arrhythmias were rare during hospitalization. In-hospital mortality and cardiac arrest were not higher in CHD patients. These results suggest that in pregnant women with CHD, cardiac events and mortality at the time delivery are uncommon.

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ACUTE KIDNEY INJURY, AS DEFINED BY THE RIFLE CRITERIA, IS ASSOCIATED WITH MORTALITY AND LENGTH OF STAY IN CHILDREN UNDERGOING SURGERY FOR CONGENITAL HEART DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)60450-6 ◽

2011 ◽

Vol 57 (14) ◽

pp. E450 ◽

Cited By ~ 1

Author(s):

Scott Aydin ◽

Howard Seiden ◽

Andrew Blaufox ◽

Vincent Parnell ◽

Tarif Choudhury ◽

...

Keyword(s):

Acute Kidney Injury ◽

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Kidney Injury ◽

Rifle Criteria

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Contemporary pregnancy outcomes for women with moderate and severe congenital heart disease

Obstetric Medicine ◽

10.1177/1753495x211064458 ◽

2021 ◽

pp. 1753495X2110644

Author(s):

Samantha A Kops ◽

Danielle D Strah ◽

Jennifer Andrews ◽

Scott E Klewer ◽

Michael D Seckeler

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Caesarean Section ◽

Length Of Stay ◽

Pregnancy Outcomes ◽

Retrospective Review ◽

Congenital Heart ◽

Admission Rates ◽

Race Ethnicity ◽

Severe Congenital Heart Disease

Background Women with congenital heart disease (CHD) are surviving into adulthood, with more undergoing pregnancy. Methods Retrospective review of the Vizient database from 2017–2019 for women 15–44 years old with moderate, severe or no CHD and vaginal delivery or caesarean section. Demographics, hospital outcomes and costs were compared. Results There were 2,469,117 admissions: 2,467,589 with no CHD, 1277 with moderate and 251 with severe CHD. Both CHD groups were younger than no CHD, there were fewer white race/ethnicity in the no CHD group and more women with Medicare in both CHD groups compared to no CHD. With increasing CHD severity there was an increase in length of stay, ICU admission rates and costs. There were also higher rates of complications, mortality and caesarean section in the CHD groups. Conclusion Pregnant women with CHD have more problematic pregnancies and understanding this impact is important to improve management and decrease healthcare utilization.

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Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2016.07.070 ◽

2016 ◽

Vol 152 (5) ◽

pp. 1423-1429.e1 ◽

Cited By ~ 14

Author(s):

Bradley Scherer ◽

Elizabeth A.S. Moser ◽

John W. Brown ◽

Mark D. Rodefeld ◽

Mark W. Turrentine ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Hospital Length ◽

Hospital Length Of Stay

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STANDARDIZATION OF CARE REDUCES LENGTH OF STAY IN POST-OPERATIVE CONGENITAL HEART DISEASE PATIENTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31235-5 ◽

2019 ◽

Vol 73 (9) ◽

pp. 627

Author(s):

Tara Cosgrove ◽

Kevin Dolan ◽

Patrick McConnell ◽

Robert Gajarski ◽

Steven Cassidy

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart

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Acute respiratory infections in hospitalised infants with congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951120004333 ◽

2020 ◽

pp. 1-9

Author(s):

Namrata Ahuja ◽

Wendy J Mack ◽

Susan Wu ◽

John C Wood ◽

Christopher J Russell

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Respiratory Infections ◽

Cross Sectional Study ◽

Acute Respiratory Infections ◽

Cross Sectional ◽

Significant Burden ◽

Inpatient Database

Abstract Objectives: To assess the overall burden and outcomes of acute respiratory infections in paediatric inpatients with congenital heart disease (CHD). Methods: This is a retrospective cross-sectional study of non-neonates <1 year with CHD in the Kid’s Inpatient Database from 2012. We compared demographics, clinical characteristics, cost, length of stay, and mortality rate for those with and without respiratory infections. We also compared those with respiratory infections who had critical CHD versus non-critical CHD. Multi-variable regression analyses were done to look for associations between respiratory infections and mortality, length of stay, and cost. Results: Of the 28,696 infants with CHD in our sample, 26% had respiratory infections. Respiratory infection-associated hospitalisations accounted for $440 million in costs (32%) for all CHD patients. After adjusting for confounders including severity, mortality was higher for those with respiratory infections (OR 1.5, p = 0.003), estimated mean length of stay was longer (14.7 versus 12.2 days, p < 0.001), and estimated mean costs were higher ($53,760 versus $46,526, p < 0.001). Compared to infants with respiratory infections and non-critical CHD, infants with respiratory infections and critical CHD had higher mortality (4.5 versus 2.3%, p < 0.001), longer mean length of stay (20.1 versus 15.5 days, p < 0.001), and higher mean costs ($94,284 versus $52,585, p < 0.001). Conclusion: Acute respiratory infections are a significant burden on infant inpatients with CHD and are associated with higher mortality, costs, and longer length of stay; particularly in those with critical CHD. Future interventions should focus on reducing the burden of respiratory infections in this population.

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Dexmedetomidine improves neurodevelopment and cognitive impairment in infants with congenital heart disease

Personalized Medicine ◽

10.2217/pme-2019-0003 ◽

2020 ◽

Vol 17 (1) ◽

pp. 33-41

Author(s):

Jianting Huang ◽

Baojing Gou ◽

Fei Rong ◽

Wei Wang

Keyword(s):

Mechanical Ventilation ◽

Congenital Heart Disease ◽

Heart Disease ◽

Cognitive Impairment ◽

Length Of Stay ◽

Neural Development ◽

Intelligence Quotient ◽

Congenital Heart ◽

Evaluation Scores ◽

Mortality Incidence

Aim: Explore if dexmedetomidine (DEX) improves neurodevelopment and cognitive impairment in infants with congenital heart disease. Materials & methods: We retrospectively analyzed 256 pediatric patients aged less than 2 years with heart disease undergoing thoracic surgery. The intelligence quotient and neurodevelopment were tested. Mortality, incidence of postoperation adverse events, duration of mechanical ventilation, and length of stay were recorded and compared. Results: Compared with those not administered DEX, intelligence quotient scores and neurodevelopment evaluation scores increased in patients receiving perioperative DEX. There were no significant differences in mortality, duration of mechanical ventilation or length of stay. Conclusion: The administration of DEX might improve neural development and reduce the adverse effects of general anesthesia in infants with congenital heart disease undergoing surgery and extracorporeal circulation.

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Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

Cardiology in the Young ◽

10.1017/s1047951119002671 ◽

2019 ◽

Vol 30 (1) ◽

pp. 62-65 ◽

Cited By ~ 3

Author(s):

Cortney B. Foster ◽

Antonio G. Cabrera ◽

Dayanand Bagdure ◽

William Blackwelder ◽

Brady S Moffett ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Hospital Length Of Stay ◽

P Value ◽

Diaphragm Dysfunction

AbstractBackground:Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.Methods:We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.Results:Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.Conclusions:Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

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