Beyond 30 Days: Analysis of Unplanned Readmissions During the First Year Following Congenital Heart Surgery

2020 ◽  
Vol 11 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Entela B. Lushaj ◽  
Joshua Hermsen ◽  
Glen Leverson ◽  
Susan G. MacLellan-Tobert ◽  
Kari Nelson ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Hospital Readmissions ◽  
Congenital Heart Surgery ◽  
First Year ◽  
Term Survival ◽  
Viral Illness ◽  
First 90 Days

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.

Alternative strategies in newborns and infants with major co-morbidities to improve congenital heart surgery outcomes at an emerging programme

2015 ◽  
Vol 26 (3) ◽  
pp. 485-492 ◽  
Author(s):  
Jannika Dodge-Khatami ◽  
Ali Dodge-Khatami ◽  
Jarrod D. Knudson ◽  
Samantha R. Seals ◽  
Avichal Aggarwal ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Surgical Strategies ◽  
Prolonged Intubation ◽  
Co Morbidity ◽  
Neonates And Infants

AbstractIntroductionDebilitating patient-related non-cardiac co-morbidity cumulatively increases risk for congenital heart surgery. At our emerging programme, flexible surgical strategies were used in high-risk neonates and infants generally considered in-operable, in an attempt to make them surgical candidates and achieve excellent outcomes.Materials and methodsBetween April, 2010 and November, 2013, all referred neonates (142) and infants (300) (average scores: RACHS 2.8 and STAT 3.0) underwent 442 primary cardiac operations: patients with bi-ventricular lesions underwent standard (n=294) or alternative (n=19) repair/staging strategies, such as pulmonary artery banding(s), ductal stenting, right outflow patching, etc. Patients with uni-ventricular hearts followed standard (n=96) or alternative hybrid (n=34) staging. The impact of major pre-operative risk factors (37%), standard or alternative surgical strategy, prematurity (50%), gestational age, low birth weight, genetic syndromes (23%), and major non-cardiac co-morbidity requiring same admission surgery (27%) was analysed on the need for extracorporeal membrane oxygenation, mortality, length of intubation, as well as ICU and hospital length of stays.ResultsThe need for extracorporeal membrane oxygenation (8%) and hospital survival (94%) varied significantly between surgical strategy groups (p=0.0083 and 0.028, respectively). In high-risk patients, alternative bi- and uni-ventricular strategies minimised mortality, but were associated with prolonged intubation and ICU stay. Major pre-operative risk factors and lower weight at surgery significantly correlated with prolonged intubation, hospital length of stay, and mortality.DiscussionIn our emerging programme, flexible surgical strategies were offered to 53/442 high-risk neonates and infants with complex CHDs and significant non-cardiac co-morbidity, in order to buffer risk and achieve patient survival, although at the cost of increased resource utilisation.

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

2020 ◽  
Author(s):  
Jennifer K. Peterson ◽  
Lazaros K. Kochilas ◽  
Jessica Knight ◽  
Courtney McCracken ◽  
Amanda S. Thomas ◽  
...  
Keyword(s):  
Trisomy 21 ◽  
Congenital Heart ◽  
Causes Of Death ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Term Survival ◽  
Long Term Survival

Reducing readmissions following paediatric cardiothoracic surgery: a quality improvement initiative

2014 ◽  
Vol 25 (5) ◽  
pp. 935-940 ◽  
Author(s):  
Brian Kogon ◽  
Kim Woodall ◽  
Kirk Kanter ◽  
Bahaaldin Alsoufi ◽  
Matt Oster
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Failure To Thrive ◽  
Congenital Heart Surgery ◽  
Cardiothoracic Surgery ◽  
Hispanic Ethnicity ◽  
Multivariate Risk ◽  
Initial Hospital

AbstractBackground: We have previously identified risk factors for readmission following congenital heart surgery – Hispanic ethnicity, failure to thrive, and original hospital stay more than 10 days. As part of a quality initiative, changes were made to the discharge process in hopes of reducing the impact. All discharges were carried out with an interpreter, medications were delivered to the hospital before discharge, and phone calls were made to families within 72 hours following discharge. We hypothesised that these changes would decrease readmissions. Methods: The current cohort of 635 patients underwent surgery in 2012. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate and multivariate risk factor analyses were performed. Comparisons were made between the initial (2009) and the current (2012) cohorts. Results: There were 86 readmissions of 77 patients during 2012. Multivariate risk factors for readmission were risk adjustment for congenital heart surgery score and initial hospital stay >10 days. In comparing 2009 with 2012, the overall readmission rate was similar (10 versus 12%, p=0.27). Although there were slight decreases in the 2012 readmissions for those patients with Hispanic ethnicity (18 versus 16%, p=0.79), failure to thrive (23 versus 17%, p=0.49), and initial hospital stay >10 days (22 versus 20%, p=0.63), they were not statistically significant. Conclusions: Potential risk factors for readmission following paediatric cardiothoracic surgery have been identified. Although targeted modifications in discharge processes can be made, they may not reduce readmissions. Efforts should continue to identify modifiable factors that can reduce the negative impact of hospital readmissions.

Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies

2020 ◽  
Vol 40 (1) ◽  
pp. 46-55
Author(s):  
Kirsti G. Catton ◽  
Jennifer K. Peterson
Keyword(s):  
Risk Factors ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Early Recognition ◽  
Treatment Options ◽  
Age Groups ◽  
Atrioventricular Node ◽  
Congenital Heart Surgery ◽  
Junctional Ectopic Tachycardia ◽  
Perioperative Morbidity

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.

Use of the Monoplane Intracardiac Imaging Probe in High-Risk Infants during Congenital Heart Surgery

2008 ◽  
Vol 25 (9) ◽  
pp. 999-1003 ◽  
Author(s):  
Lisa R. Drinker ◽  
Michael G.W. Camitta ◽  
James Rene Herlong ◽  
Stephen Miller ◽  
Andrew J. Lodge ◽  
...  
Keyword(s):  
High Risk ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Imaging Probe ◽  
High Risk Infants

scholarly journals Risk Factors for Death After Adult Congenital Heart Surgery in Pediatric Hospitals

2011 ◽  
Vol 4 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Yuli Y. Kim ◽  
Kimberlee Gauvreau ◽  
Emile A. Bacha ◽  
Michael J. Landzberg ◽  
Oscar J. Benavidez
Keyword(s):  
Risk Factors ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Pediatric Hospitals ◽  
Adult Congenital

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

Circulation ◽  
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.

A retrospective study of perioperative clinical seizures and epilepsy in children after operation for CHD

2021 ◽  
pp. 1-7
Author(s):  
Takeshi Ikegawa ◽  
Shin Ono ◽  
Kouji Yamamoto ◽  
Mikihiro Shimizu ◽  
Sadamitsu Yanagi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
White Matter ◽  
Risk Adjustment ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
White Matter Integrity ◽  
Partial Regression Coefficient ◽  
Clinical Seizure

Abstract This study investigated the incidence and risk factors of perioperative clinical seizure and epilepsy in children after operation for CHD. We included 777 consecutive children who underwent operation from January 2013 to December 2016 at Kanagawa Children’s Medical Center, Kanagawa, Japan. Perinatal, perioperative, and follow-up medical data were collected. Elastic net regression and mediation analysis were performed to investigate risk factors of perioperative clinical seizure and epilepsy. Anatomic CHD classification was performed based on the preoperative echocardiograms; cardiac surgery was evaluated using Risk Adjustment in Congenital Heart Surgery 1. Twenty-three (3.0%) and 15 (1.9%) patients experienced perioperative clinical seizure and epilepsy, respectively. Partial regression coefficient with epilepsy as the objective variable for anatomical CHD classification, Risk Adjustment in Congenital Heart Surgery 1, and the number of surgeries was 0.367, 0.014, and 0.142, respectively. The proportion of indirect effects on epilepsy via perioperative clinical seizure was 22.0, 21.0, and 33.0%, respectively. The 15 patients with epilepsy included eight cases with cerebral infarction, two cases with cerebral haemorrhage, and three cases with hypoxic-ischaemic encephalopathy; white matter integrity was not found. Anatomical complexity of CHD, high-risk cardiac surgery, and multiple cardiac surgeries were identified as potential risk factors for developing epilepsy, with a low rate of indirect involvement via perioperative clinical seizure and a high rate of direct involvement independently of perioperative clinical seizure. Unlike white matter integrity, stroke and hypoxic-ischaemic encephalopathy were identified as potential factors for developing epilepsy.

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