Long-Term Survival and Causes of Death in Children with Trisomy 21 After Congenital Heart Surgery

Objective: We investigated the incidence and etiologies for unplanned hospital readmissions during the first year following congenital heart surgery (CHS) at our institution and the potential association of readmissions with longer term survival. Methods: We retrospectively reviewed 263 patients undergoing CHS at our institution from August 2011 to June 2015. Scheduled readmissions were excluded. Results: Seventy patients accrued a total of 120 readmissions (1.7 readmission/patient) within one year after surgery. The first readmission for 57% of the patients was within 30 days postdischarge. Twenty-two patients were first readmitted between 31 and 90 days postdischarge. Eight patients were first readmitted between 90 days and 1 year postdischarge. Median time-to-first readmission was 21 days. Median hospital length of stay at readmission was two days. Causes of 30-day readmissions included viral illness (25%), wound infections (15%), and cardiac causes (15%). Readmissions between 30 and 90 days included viral illness (27%), gastrointestinal (27%), and cardiac causes (9%). Age, STAT category, length of surgery, intubation, intensive care unit, and hospital stay were risk factors associated with readmissions based on logistic regression. Distance to hospital had a significant effect on readmissions ( P < .001). Patients with higher family income were less likely to be readmitted ( P < .001). There was no difference in survival between readmitted and non-readmitted patients ( P = .68). Conclusions: The first 90 days is a high-risk period for unplanned hospital readmissions after CHS. Complicated postoperative course, higher surgical complexity, and lower socioeconomic status are risk factors for unplanned readmissions the first 90 days after surgery. Efforts to improve the incidence or readmission after CHS should extend to the first 3 months after surgery and target these high-risk patient populations.

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Long-term survival and competing causes of death in Hodgkin's disease (HD)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(00)80267-9 ◽

2000 ◽

Vol 48 (3) ◽

pp. 236

Author(s):

A.K Ng ◽

M.P Bernardo ◽

E Weller ◽

B Silver ◽

K Backstrand ◽

...

Keyword(s):

Hodgkin's Disease ◽

Causes Of Death ◽

Hodgkin’S Disease ◽

Term Survival ◽

Long Term Survival ◽

Competing Causes

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Prescription medication use after congenital heart surgery

Cardiology in the Young ◽

10.1017/s1047951121005060 ◽

2022 ◽

pp. 1-8

Author(s):

Alireza Raissadati ◽

Jari Haukka ◽

Tommi Pätilä ◽

Heta Nieminen ◽

Eero Jokinen

Keyword(s):

General Population ◽

Congenital Heart ◽

Heart Surgery ◽

Medication Use ◽

Prescription Medication ◽

Congenital Heart Surgery ◽

Hazard Ratio ◽

Prescription Medications

Abstract Background: Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. Methods: Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. Results: Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7–2.1; severe hazard ratio 6.5, 95% confidence interval 5.3–8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8–3.7; severe hazard ratio 38.8, 95% CI 27.5–54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. Conclusions: The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.

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Abstract P180: Hospital Readmission After Pediatric Congenital Heart Surgery: A Systematic Review And Meta-analysis Of Potential Risk Factors

Circulation ◽

10.1161/circ.143.suppl_1.p180 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Meagan E Stabler ◽

Devin M Parker ◽

Sarina Kothari ◽

Mahalia Dalmage ◽

Heather Johnson ◽

...

Keyword(s):

Hospital Readmission ◽

Congenital Heart ◽

Heart Surgery ◽

Meta Analysis ◽

Hospital Readmissions ◽

Congenital Heart Surgery ◽

Risk Of Bias ◽

Factors Associated ◽

Short And Long Term

Objective: Over 40,000 infants are born annually with a heart defect; 25% require surgery and of those 20% result in hospital readmissions. We sought to identify risk factors for short- and long-term readmission following pediatric congenital heart surgery (CHS) to reduce avoidable future admissions. Methods: A systematic approach was used to search four electronic databases and retrieve articles published through 05/2020. We included observational and experimental studies that observed factors associated with 30-day or 1-year readmission after CHS. Studies with a composite outcome of readmission and death were excluded. For each independent risk factor, we assessed the pooled effect size and heterogeneity using a random-effects model. Risk of bias was assessed via the Newcastle-Ottawa scale. Results: After removing 970 duplicates, we screened 5,084 studies; 17 were included in the systematic review and 15 (N= 82,794; 9,856 readmitted) in the meta-analysis. Hospital readmission was significantly and positively associated with gestational age, non-white race, Hispanic ethnicity, government insurance, genetic abnormality, renal dysfunction, failure to thrive, mechanical ventilation, intraoperative ventricular dysfunction, RACHS score, STAT mortality score, cross clamp time, gastroesophageal reflux disease, postoperative arrhythmia, valve regurgitation, feeding difficulties, and ICU and hospital length of stay (LOS). Readmission definition (i.e., 1-yr vs 30-day) and LOS dichotomization (i.e., ≥ 10 or ≥ 14) resulted in significant subgroup differences for age at surgery and LOS. Five studies had higher potential for risk of bias. Conclusions: This is the first meta-analysis to identify patient and clinical factors associated with short and long-term readmission after pediatric CHS. Findings may support clinical decisions before undergoing surgery and identify patients that may benefit from receiving more aggressive care transitions prior to discharge to reduce avoidable hospital readmissions.

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Trends in Long-Term Mortality After Congenital Heart Surgery

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.03.491 ◽

2018 ◽

Vol 71 (21) ◽

pp. 2434-2446 ◽

Cited By ~ 43

Author(s):

Logan G. Spector ◽

Jeremiah S. Menk ◽

Jessica H. Knight ◽

Courtney McCracken ◽

Amanda S. Thomas ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Long Term Mortality

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Congenital heart disease in the adult

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.1612_update_002 ◽

2010 ◽

pp. 2842-2872

Author(s):

S. A. Thorne

Keyword(s):

Congenital Heart Disease ◽

United Kingdom ◽

Heart Disease ◽

Congenital Heart ◽

Specialist Care ◽

Term Survival ◽

Long Term Survival ◽

The United Kingdom ◽

Growing Population

Adults with congenital heart disease are a growing population, and now outnumber children with congenital heart disease in the United Kingdom. Many patients with repaired hearts can now, with specialist care, expect to live a normal or near normal lifespan. Other survivors have complex, surgically altered hearts and circulations that reflect the surgical and interventional practices of the preceding two decades. Their long-term outlook is unknown and they remain at lifelong risk of complications that may require further intervention. The organization of services to provide specialist care is key to their long-term survival....

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