Risk Factors for Increased Hospital Resource Utilization and In-Hospital Mortality in Adults With Single Ventricle Congenital Heart Disease

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.

Download Full-text

Abstract 11013: Resource Utilization for Non-Cardiac Hospital Admissions in Patients With Single Ventricle Congenital Heart Disease

Circulation ◽

10.1161/circ.130.suppl_2.11013 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ian D Thomas ◽

Michael D Seckeler

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Resource Utilization ◽

Congenital Heart ◽

Single Ventricle ◽

Hospital Admissions ◽

Hospital Costs ◽

Admission Rate ◽

Discharge Data ◽

Surgical Palliation

Background: Patients with single ventricle (SV) congenital heart disease (CHD) incur high hospital costs during staged surgical palliation. However, resource utilization for non-cardiac admissions in SV patients has not been reported. This study sought to compare costs for common non-cardiac hospital admissions between SV patients and patients without CHD. Methods: A retrospective review of hospital discharge data from the University HealthSystem Consortium (UHC) from January 2011 through December 2013 was performed. UHC collects discharge data from 120 academic institutions and 302 affiliated hospitals. The database was queried for patients <18 years of age with ICD-9 codes for SV lesions: hypoplastic left heart syndrome (746.7), tricuspid atresia (746.1) or common ventricle (745.3). Neonates (<30 days old) were excluded to eliminate hospitalizations for Stage 1 surgical palliation. Primary diagnosis, direct cost, length of stay (LOS), ICU admission rate and mortality data were obtained. The eight most common non-cardiac admission diagnoses were compared between SV patients and non-CHD patients using t-test and Fisher’s exact test, as appropriate. Results: The non-cardiac admission diagnoses, with ICD-9 codes, and comparisons between SV and non-CHD patients are shown in the Table. Total direct cost, LOS and ICU admission rate were higher for SV patients for all diagnoses with the exception of LOS for failure to thrive, which was not different between groups. Notably, hospital mortality was markedly higher for SV patients admitted for RSV bronchiolitis or pneumonia. Conclusions: Hospital costs for common non-cardiac diagnoses are higher for patients with SV CHD. As long-term survival of SV CHD patients increase they will utilize a disproportionate amount of medical dollars, as our study shows. Further characterization of SV CHD patient costs will be important so steps can be taken to reduce or prevent hospitalization in these patients.

Download Full-text

Prevalence and Risk Factors Associated with Renal Dysfunction in Patients with Single Ventricle Congenital Heart Disease after Fontan Palliation

Congenital Heart Disease ◽

10.32604/chd.2020.012097 ◽

2020 ◽

Vol 15 (4) ◽

pp. 181-195

Author(s):

Sheetal R. Patel ◽

David M. Kwiatkowski ◽

Adin-Cristian ◽

rei ◽

Ankita Devareddy ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Renal Dysfunction ◽

Congenital Heart ◽

Single Ventricle ◽

Factors Associated ◽

Fontan Palliation

Download Full-text

PEDIATRIC HOSPITAL RESOURCE UTILIZATION FOR HEART FAILURE AMONG ADULTS WITH CONGENITAL HEART DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31101-x ◽

2018 ◽

Vol 71 (11) ◽

pp. A560

Author(s):

Jonathan Chan ◽

Ronnie Collins ◽

Anitha John

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Resource Utilization ◽

Congenital Heart ◽

Pediatric Hospital ◽

Hospital Resource

Download Full-text

PREVALENCE AND RISK FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE IN PATIENTS WITH SINGLE VENTRICLE CONGENITAL HEART DISEASE AFTER FONTAN PALLIATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)33975-x ◽

2017 ◽

Vol 69 (11) ◽

pp. 586 ◽

Cited By ~ 1

Author(s):

Sheetal Patel ◽

David Kwiatkowski ◽

Adin-Cristian Andrei ◽

Ankita Devareddy ◽

Catherine Krawczeski ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Congenital Heart Disease ◽

Heart Disease ◽

Kidney Disease ◽

Congenital Heart ◽

Single Ventricle ◽

Factors Associated ◽

Fontan Palliation

Download Full-text

Severe postoperative hyperbilirubinemia in congenital heart disease

Open Medicine ◽

10.1515/med-2021-0316 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1276-1285

Author(s):

Xiaolan Chen ◽

Ming Bai ◽

Shiren Sun ◽

Xiangmei Chen

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Hospital Mortality ◽

Congenital Heart ◽

Kidney Injury ◽

Term Survival ◽

Risk Of Mortality ◽

Long Term Mortality

Abstract Purpose The purpose of our present study was to explore the characteristics and outcomes of congenital heart disease (CHD) patients with severe postoperative hyperbilirubinemia. Methods All patients who underwent cardiopulmonary bypass surgical treatment for CHD and had severe postoperative hyperbilirubinemia (total bilirubin [TB] ≥85.5 μmol/L) in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were employed to identify risk factors for the study endpoints, including postoperative acute kidney injury (AKI), in-hospital mortality, and long-term mortality. Results After screening, 86 patients were included in our present study. In-hospital mortality was 10.9%. Fifty-one (59.3%) patients experienced AKI, and four (4.7%) patients received continuous renal replacement therapy. Multivariate analysis identified that the peak TB concentration (P = 0.002) and duration of mechanical ventilation (P = 0.008) were independent risk factors for in-hospital mortality, and stage 3 AKI was an independent risk factor for long-term mortality. The optimal cutoff value for peak TB concentration was 125.9 μmol/L. Patients with a postoperative TB level ≥125.9 μmol/L had worse long-term survival. Conclusion Hyperbilirubinemia was a common complication after CHD surgery. CHD patients with severe postoperative hyperbilirubinemia ≥125.9 μmol/L and AKI had a higher risk of mortality.

Download Full-text