Feeding outcomes after paediatric cardiothoracic surgery: a retrospective review

2021 ◽  
pp. 1-9
Author(s):  
Robert Hill ◽  
Ching S. Tey ◽  
Calvin Jung ◽  
Robert Monfort ◽  
Brian Pettitt-Schieber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Retrospective Chart Review ◽  
Feeding Tube ◽  
Congenital Heart Surgery ◽  
Feeding Difficulties ◽  
Included Patient ◽  
Management Protocol ◽  
Language Pathology

Abstract Background: Feeding difficulty is a known complication of congenital heart surgery. Despite this, there is a relative sparsity in the available data regarding risk factors, incidence, associated symptoms, and outcomes. Methods: In this retrospective chart review, patients aged 0–18 years who underwent congenital heart surgery at a single institution between January and December, 2017 were reviewed. Patients with feeding difficulties before surgery, multiple surgeries, and potentially abnormal recurrent laryngeal nerve anatomy were excluded. Data collected included patient demographics, feeding outcomes, post-operative symptoms, flexible nasolaryngoscopy findings, and rates of readmission within a 1-year follow-up period. Multivariable regression analyses were performed to evaluate the risk of an alternative feeding plan at discharge and length of stay. Results: Three-hundred and twenty-six patients met the inclusion criteria for this study. Seventy-two (22.09%) were discharged with a feeding tube and 70 (97.22%) of this subgroup were younger than 12 months at the time of surgery. Variables that increased the risk of being discharged with a feeding tube included patient age, The Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery score, procedure group, aspiration, and reflux. Speech-language pathology was the most frequently utilised consulting service for patients discharged with feeding tubes (90.28%) while other services were not frequently consulted. The median length of stay was increased from 4 to 10 days for patients who required an enteral feeding tube at discharge. Discussion: Multidisciplinary management protocol and interventions should be developed and standardised to improve feeding outcomes following congenital heart surgery.

scholarly journals Pediatric Cardiac Surgical Patterns of Practice and Outcomes in Japan and Europe

2021 ◽  
Vol 12 (3) ◽  
pp. 312-319
Author(s):  
Jürgen Hörer ◽  
Yasutaka Hirata ◽  
Hisateru Tachimori ◽  
Masamichi Ono ◽  
Vladimiro Vida ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Discharge ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Septal Defect ◽  
Congenital Heart Surgery ◽  
Atrioventricular Septal Defect ◽  
Postoperative Length ◽  
Surgery Mortality ◽  
Patterns Of Practice

Objectives: The Japan Cardiovascular Surgery Database–Congenital section (JCVSD-Congenital) and the European Congenital Heart Surgeons Association (ECHSA) Congenital Heart Surgery Database (CHSD) share the same nomenclature. We aimed at comparing congenital cardiac surgical patterns of practice and outcomes in Japan and Europe using the JCVSD-Congenital and ECHSA-CHSD. Methods and Results: We examined Japanese (120 units, 63,365 operations) and European (96 units, 90,098 operations) data in JCVSD-Congenital and ECHSA-CHSD from 2011 to 2017. Patients’ age and weight, periprocedural times, mortality at hospital discharge, and postoperative length of stay were calculated for ten benchmark operations. There was a significantly higher proportion of ventricular septal defect closures and Glenn operations and a significantly lower proportion of coarctation repairs, tetralogy of Fallot repairs, atrioventricular septal defect repairs, arterial switch operations, truncus repairs, Norwood operations, and Fontan operations in JCVSD-Congenital compared to ECHSA-CHSD. Postoperative length of stay was significantly longer following all benchmark operations in JCVSD-Congenital compared to ECHSA-CHSD. Mean STAT mortality score (Society of Thoracic Surgeons European Association for Cardio-Thoracic Surgery mortality score) was significantly higher in JCVSD-Congenital (0.78) compared to ECHSA-CHSD (0.71). Mortality at hospital discharge was significantly lower in JCVSD-Congenital (4.2%) compared to ECHSA-CHSD (6.0%, P < .001). Conclusions: The distribution of the benchmark procedures and age at the time of surgery differ between Japan and Europe. Postoperative length of stay is longer, and the mean complexity is higher in Japan compared to European data. These comparisons of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.

Abstract 4570: Association Between Intra-operative and Early Postoperative Glucose Levels and Adverse Outcomes Following Complex Congenital Heart Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Angelo Polito ◽  
Ravi R Thigarajan ◽  
Peter C Laussen ◽  
Kimberlee Gauvreau ◽  
Michael S Agus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Glucose Control ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Composite Endpoint ◽  
Congenital Heart Surgery ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Glucose Levels ◽  
Multiple Variables

Although hyperglycemia is associated with increased mortality in critically ill adults, studies in children undergoing cardiac surgery are limited and have reached conflicting conclusions. We sought to determine whether associations exist between perioperative glucose exposure, prolonged hospitalization and morbid events following complex congenital heart surgery. Metrics of glucose control including average, peak, minimum and standard deviation of glucose levels, and duration of hyperglycemia (hours >126 mg/dL and 200 mg/dL) were determined intraoperatively and for 72 hours following surgery for 378 consecutive children who had a Risk Adjustment in Congenital Heart Surgery-1 category ≥3. Regression analyses were used to determine relationships between glucose variables, hospital length of stay and a composite morbidity-mortality outcome (death, ECMO, infection, hepatic injury, renal failure, and/or brain injury) after controlling for multiple variables known to influence early outcomes. Intraoperatively, a minimum glucose ≤75 mg/dL was associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.49 – 6.48), but other metrics of glucose control were not associated with the composite endpoint or length of stay. Greater duration of hyperglycemia (glucose >126 mg/dl) during the first 72 postoperative hours was associated with longer duration of hospitalization (p<0.001). In the 72 hours after surgery, average glucose <110 mg/dl (OR, 7.30; 95% CI, 1.95–27.25) or >143 mg/dl (OR, 5.21, 95% CI, 1.37–19.89), minimum glucose ≤75 mg/dL (OR, 2.85, 95% CI, 1.38 –5.88), and peak glucose level ≥250 mg/dl (OR, 2.55, 95% CI, 1.20 –5.43) were all associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint. In children undergoing complex congenital heart surgery, intraoperative hyperglycemia was not associated with adverse outcomes. When considering analyses of several metrics of glucose control, the optimal postoperative glucose range may be 110 –126 mg/dl. A randomized trial of strict glycemic control achieved with insulin infusions in this patient population is needed.

Alpha-blockade during congenital heart surgery admissions: analysis from national database

2021 ◽  
pp. 1-7
Author(s):  
Brian Lee ◽  
Enrique G. Villarreal ◽  
Emad B. Mossad ◽  
Jacqueline Rausa ◽  
Ronald A. Bronicki ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Univariate Analysis ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Alpha Blockade ◽  
Stay Hospital

Abstract Introduction: The effects of alpha-blockade on haemodynamics during and following congenital heart surgery are well documented, but data on patient outcomes, mortality, and hospital charges are limited. The purpose of this study was to characterise the use of alpha-blockade during congenital heart surgery admissions and to determine its association with common clinical outcomes. Materials and Methods: A cross-sectional study was conducted using the Pediatric Health Information System database. De-identified data for patients under 18 years of age with a cardiac diagnosis who underwent congenital heart surgery were obtained from 2004 to 2015. Patients were subdivided on the basis of receiving alpha-blockade with either phenoxybenzamine or phentolamine during admission or not. Continuous and categorical variables were analysed using Mann−Whitney U-tests and Fisher exact tests, respectively. Characteristics between subgroups were compared using univariate analysis. Regression analyses were conducted to determine the impact of alpha-blockade on ICU length of stay, hospital length of stay, billed charges, and mortality. Results: Of the 81,313 admissions, 4309 (5.3%) utilised alpha-blockade. Phentolamine was utilised in 4290 admissions. In univariate analysis, ICU length of stay, total length of stay, inpatient mortality, and billed charges were all significantly higher in the alpha-blockade admissions. However, regression analyses demonstrated that other factors were behind these increased. Alpha-blockade was significantly, independently associated with a 1.5 days reduction in ICU length of stay (p < 0.01) and a 3.5 days reduction in total length of stay (p < 0.01). Alpha-blockade was significantly, independently associated with a reduction in mortality (odds ratio 0.8, 95% confidence interval 0.7−0.9). Alpha-blockade was not independently associated with any significant change in billed charges. Conclusions: Alpha-blockade is used in a subset of paediatric cardiac surgeries and is independently associated with significant reductions in ICU length of stay, hospital length of stay, and mortality without significantly altering billed charges.

scholarly journals Evidence-Based Fetal Referrals for Congenital Heart Surgery

2012 ◽  
Vol 5 (1) ◽  
pp. 1-7
Author(s):  
Cynthia Elaine Battiste ◽  
Margaret Helen O’Hara ◽  
Steven Wayne Allen
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Retrospective Chart Review ◽  
Congenital Heart Surgery ◽  
Third Party ◽  
Transport Costs ◽  
Neonatal Transport ◽  
Cost Differential

Background. The outcomes of fetal referrals to congenital heart disease centers for delivery and postnatal surgery prior to discharge over a two-year period were reviewed. Cost differences between fetal referrals and neonatal transports were investigated. Methods. A retrospective chart review was conducted on 17 fetal referrals to two congenital heart disease centers from 01/01/2007 to 12/31/2008. The two centers were contacted to obtain their neonatal transport charges. Results. Of the 17 fetal referrals, 10 patients underwent congenital heart surgery prior to postnatal discharge. Only one patient who underwent surgery died. Third party payers saved approximately $13,600 or $36,600 in neonatal transport costs to these centers. Conclusions. There was only one death of a patient with hypoplastic left heart syndrome and a restrictive atrial septum, which has a poor prognosis. There was a significant cost differential between fetal referral and neonatal transport.

Impact of miniaturized cardiopulmonary bypass circuits on ultrafiltration during congenital heart surgery

Perfusion ◽  
2020 ◽  
pp. 026765912096720
Author(s):  
Keye Wu ◽  
Baoying Meng ◽  
Yuanxiang Wang ◽  
Xing Zhou ◽  
Sheshe Zhang ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Length Of Stay ◽  
Retrospective Analysis ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Clinical Results ◽  
Congenital Heart Surgery ◽  
The Other ◽  
Children's Hospital ◽  
Preoperative Weight

Objective: To investigate whether the miniaturized cardiopulmonary bypass (CPB) system decreased the usage of ultrafiltration (UF), and to explore whether the non-UF with miniaturized CPB strategy could get good clinical results during congenital heart surgery. Methods: We performed a retrospective analysis of all patients undergoing congenital heart surgery with CPB at Shenzhen Children’s Hospital from 1 May 2015 to 30 September 2019. We classified patients to UF with miniaturized CPB group, non-UF with miniaturized CPB group, UF with conventional CPB group and non-UF with conventional CPB group. Results: Of the 2145 patients, 721 (33.6%) were in the conventional CPB group, and 1424 (66.4%) were in the miniaturized CPB group. The UF rate was significantly lower in the miniaturized CPB group compared with that in the conventional CPB group (12.5% vs. 76.8%, p < 0.001). Compared with patients in the other groups, patients in the non-UF with miniaturized CPB group had a shorter postoperative MV time (p < 0.05), and a shorter length of stay in the ICU (p < 0.001) and hospital (p < 0.001). The age of children in the UF with miniaturized CPB group was relatively younger (median: 1.5 months, IQR: 0.3-4.6 months), and the preoperative weight was relatively lower (median: 3.9 kg, IQR: 3.2-5.4 kg). Moreover, this group of children had a relatively longer postoperative MV time and length of stay in the ICU and hospital. Conclusion: The miniaturized CPB system could decrease the usage of UF. Good results were achieved in children who did not use UF based on the miniaturized CPB circuit system during congenital heart surgery.

Peritoneal dialysis during congenital heart surgery admissions: insights from a large database

2020 ◽  
Vol 30 (4) ◽  
pp. 451-455
Author(s):  
Rohit S. Loomba ◽  
Enrique G. Villarreal ◽  
Ronald A. Bronicki ◽  
Saul Flores
Keyword(s):  
Peritoneal Dialysis ◽  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Septal Defect ◽  
Congenital Heart Surgery ◽  
Fluid Restriction ◽  
Specific Patient ◽  
Left Heart Syndrome ◽  
Univariate Analyses

AbstractBackground:The management of fluid overload after congenital heart surgery has been limited to diuretics, fluid restriction, and dialysis. This study was conducted to determine the association between peritoneal dialysis and important clinical outcomes in children undergoing congenital heart surgery.Methods:A retrospective review was conducted to identify patients under 18 years of age who underwent congenital heart surgery. The data were obtained over a 16-year period (1997–2012) from the Kids’ Inpatient Database. Data analysed consisted of demographics, diagnoses, type of congenital heart surgery, length of stay, cost of hospitalisation, and mortality. Logistic regression was performed to determine factors associated with peritoneal dialysis.Results:A total of 46,176 admissions after congenital heart surgery were included in the study. Of those, 181 (0.4%) utilised peritoneal dialysis. The mean age of the peritoneal dialysis group was 7.6 months compared to 39.6 months in those without peritoneal dialysis. The most common CHDs were atrial septal defect (37%), ventricular septal defect (32.6%), and hypoplastic left heart syndrome (18.8%). Univariate analyses demonstrated significantly greater length of stay, cost of admission, and mortality in those with peritoneal dialysis. Regression analyses demonstrated that peritoneal dialysis was independently associated with significant decrease in cost of admission (−$57,500) and significant increase in mortality (odds ratio 1.5).Conclusions:Peritoneal dialysis appears to be used in specific patient subsets and is independently associated with decreased cost of stay, although it is associated with increased mortality. Further studies are needed to describe risks and benefit of peritoneal dialysis in this population.

scholarly journals National Variation in Congenital Heart Surgery Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (14) ◽  
pp. 1351-1360
Author(s):  
Sara K. Pasquali ◽  
Dylan Thibault ◽  
Sean M. O’Brien ◽  
Jeffrey P. Jacobs ◽  
J. William Gaynor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Lower Risk ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Risk Group ◽  
Congenital Heart Surgery ◽  
Morbidity And Mortality ◽  
Hospital Variation ◽  
Major Complications ◽  
Surgery Outcomes

Background: Optimal strategies to improve national congenital heart surgery outcomes and reduce variability across hospitals remain unclear. Many policy and quality improvement efforts have focused primarily on higher-risk patients and mortality alone. Improving our understanding of both morbidity and mortality and current variation across the spectrum of complexity would better inform future efforts. Methods: Hospitals participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2014–2017) were included. Case mix–adjusted operative mortality, major complications, and postoperative length of stay were evaluated using Bayesian models. Hospital variation was quantified by the interdecile ratio (IDR, upper versus lower 10%) and 95% credible intervals (CrIs). Stratified analyses were performed by risk group (Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery [STAT] category) and simulations evaluated the potential impact of reductions in variation. Results: A total of 102 hospitals (n=84 407) were included, representing ≈85% of US congenital heart programs. STAT category 1 to 3 (lower risk) operations comprised 74% of cases. All outcomes varied significantly across hospitals: adjusted mortality by 3-fold (upper versus lower decile 5.0% versus 1.6%, IDR 3.1 [95% CrI 2.5–3.7]), mean length of stay by 1.8-fold (19.2 versus 10.5 days, IDR 1.8 [95% CrI 1.8–1.9]), and major complications by >3-fold (23.5% versus 7.0%, IDR 3.4 [95% CrI 3.0–3.8]). The degree of variation was similar or greater for low- versus high-risk cases across outcomes, eg, ≈3-fold mortality variation across hospitals for STAT 1 to 3 (IDR 3.0 [95% CrI 2.1–4.2]) and STAT 4 or 5 (IDR 3.1 [95% CrI 2.4–3.9]) cases. High-volume hospitals had less variability across outcomes and risk categories. Simulations suggested potential reductions in deaths (n=282), major complications (n=1539), and length of stay (101 183 days) over the 4-year study period if all hospitals were to perform at the current median or better, with 37% to 60% of the improvement related to the STAT 1 to 3 (lower risk) group across outcomes. Conclusions: We demonstrate significant hospital variation in morbidity and mortality after congenital heart surgery. Contrary to traditional thinking, a substantial portion of potential improvements that could be realized on a national scale were related to variability among lower-risk cases. These findings suggest modifications to our current approaches to optimize care and outcomes in this population are needed.

The risk associated with concomitant procedures performed during adult congenital heart surgery

2015 ◽  
Vol 26 (5) ◽  
pp. 909-914
Author(s):  
Makoto Mori ◽  
Joshua M. Rosenblum ◽  
Wendy Book ◽  
Matt Oster ◽  
Brian Kogon
Keyword(s):  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Pulmonary Valve ◽  
Congenital Heart Surgery ◽  
Valve Surgery ◽  
Major Adverse Event ◽  
Prolonged Length ◽  
Adult Congenital ◽  
Major Adverse Events

AbstractBackgroundAdult patients with CHD often require complex operations, and indications for particular aspects of the operation are sometimes unclear. The aims of our study were as follows: to characterise concomitant procedures performed during adult congenital cardiac surgery, and to better define the risk involved with performing concomitant procedures during a single operation.MethodsWe retrospectively studied 458 adult congenital cardiac surgical patients. Major procedures were characterised as aortic, mitral, pulmonary, tricuspid, septal defect, single ventricle, transplant, and others. We constructed logistic regression models to assess the risk for mortality, major adverse event, and prolonged length of stay.ResultsA total of 362 operations involved a single major procedure, whereas 96 involved concomitant procedures. Performing concomitant procedures increased mortality (7.3 versus 2.5%), major adverse events (21.8 versus 14.9%), and prolonged length of stay (29.2 versus 17.1%). The added risks of concomitant procedures on mortality, major adverse event, and prolonged length of stay were 2.9 (95% CI 1.0–8.5, p=0.05), 1.9 (95% CI 1.1–3.3, p=0.02), and 2.4 (95% CI 1.4–4.1, p=0.003), respectively. There were 200 patients with conotruncal anomalies who underwent pulmonary valve surgery. In this subset, the added risks of concomitant procedures in addition to pulmonary valve surgery on mortality, major adverse events, and prolonged length of stay were 6.6 (95% CI 1.2–37.3, p=0.03), 2.8 (95% CI 1.2–6.6, p=0.03), and 3.3 (95% CI 1.5–7.4, p=0.005), respectively.ConclusionConcomitant procedures performed during adult congenital heart surgery increase risk. Awareness of this risk may improve surgical decision making and outcomes.

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

2019 ◽  
Vol 30 (1) ◽  
pp. 62-65 ◽  
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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