Center-level factors associated with shorter length of stay following stage 1 palliation: An analysis of the national pediatric cardiology quality improvement collaborative registry.
| Title: | Center-level factors associated with shorter length of stay following stage 1 palliation: An analysis of the national pediatric cardiology quality improvement collaborative registry. |
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| Authors: | Foote HP; Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC.; Thibault D; Duke Clinical Research Institute, Durham, NC.; Gonzalez CD; Duke University School of Medicine, Durham, NC.; Hill GD; Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.; Minich LL; Department of Pediatrics, The University of Utah and Primary Children's Hospital, Salt Lake City, UT.; Overbey DM; Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.; Tallent SL; Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC.; Hill KD; Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: kevin.hill@duke.edu.; McCrary AW; Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC. |
| Source: | American heart journal [Am Heart J] 2023 Nov; Vol. 265, pp. 143-152. Date of Electronic Publication: 2023 Aug 10. |
| Publication Type: | Journal Article; Research Support, N.I.H., Extramural |
| Language: | English |
| Journal Info: | Publisher: Mosby Country of Publication: United States NLM ID: 0370465 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6744 (Electronic) Linking ISSN: 00028703 NLM ISO Abbreviation: Am Heart J Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: St. Louis, MO : Mosby |
| MeSH Terms: | Heart Defects, Congenital*/surgery ; Hypoplastic Left Heart Syndrome*/surgery ; Cardiac Surgical Procedures* ; Norwood Procedures*; Infant ; Child ; Humans ; Male ; Female ; Length of Stay ; Treatment Outcome ; Quality Improvement ; Registries ; Palliative Care ; Retrospective Studies |
| Abstract: | Background: Stage 1 single ventricle palliation (S1P) has the longest length of stay (LOS) of all benchmark congenital heart operations. Center-level factors contributing to prolonged hospitalization are poorly defined.; Methods: We analyzed data from infants status post S1P included in the National Pediatric Cardiology Quality Improvement Collaborative Phase II registry. Our primary outcome was patient-level LOS with days alive and out of hospital before stage 2 palliation (S2P) used as a balancing measure. We compared patient and center-level characteristics across quartiles for median center LOS, and used multivariable regression to calculate center-level factors associated with LOS after adjusting for case mix.; Results: Of 2,510 infants (65 sites), 2037 (47 sites) met study criteria (61% male, 61% white, 72% hypoplastic left heart syndrome). There was wide intercenter variation in LOS (first quartile centers: median 28 days [IQR 19, 46]; fourth quartile: 62 days [35, 95], P < .001). Mortality prior to S2P did not differ across quartiles. Shorter LOS correlated with more pre-S2P days alive and out of hospital, after accounting for readmissions (correlation coefficient -0.48, P < .001). In multivariable analysis, increased use of Norwood with a right ventricle to pulmonary artery conduit (aOR 2.65 [1.1, 6.37]), shorter bypass time (aOR 0.99 per minute [0.98,1.0]), fewer additional cardiac operations (aOR 0.46 [0.22, 0.93]), and increased use of NG tubes rather than G tubes (aOR 7.03 [1.95, 25.42]) were all associated with shorter LOS centers.; Conclusions: Modifiable center-level practices may be targets to standardize practice and reduce overall LOS across centers.; (Copyright © 2023 Elsevier Inc. All rights reserved.) |
| References: | Circulation. 2014 May 20;129(20):2013-20. (PMID: 24705119); Pediatrics. 2011 Nov;128(5):e1181-6. (PMID: 21987703); Ann Thorac Surg. 2012 Jun;93(6):1992-7. (PMID: 22516833); Am Heart J. 2022 Dec;254:216-227. (PMID: 36115392); Congenit Heart Dis. 2011 Mar-Apr;6(2):116-27. (PMID: 21426525); Pediatr Cardiol. 2014 Mar;35(3):431-40. (PMID: 24104215); Ann Thorac Surg. 2019 Jun;107(6):1816-1823. (PMID: 30742819); J Thorac Cardiovasc Surg. 2020 Oct;160(4):1021-1030. (PMID: 31924360); J Am Heart Assoc. 2019 May 21;8(10):e010783. (PMID: 31112448); Ann Thorac Surg. 2014 Nov;98(5):1660-6. (PMID: 25201725); J Thorac Cardiovasc Surg. 2012 Oct;144(4):882-95. (PMID: 22704284); Cardiol Young. 2016 Apr;26(4):683-92. (PMID: 26169083); J Thorac Cardiovasc Surg. 2013 Apr;145(4):1046-1057.e1. (PMID: 22835225); Pediatrics. 2015 Oct;136(4):e864-70. (PMID: 26391936); Curr Opin Cardiol. 2013 Mar;28(2):97-102. (PMID: 23337893); BMJ. 2007 Oct 20;335(7624):806-8. (PMID: 17947786); J Thorac Cardiovasc Surg. 2015 Sep;150(3):474-80.e2. (PMID: 26242838); Pediatrics. 2022 Jul 1;150(1):. (PMID: 35491483); J Thorac Cardiovasc Surg. 2012 Oct;144(4):896-906. (PMID: 22795436); Ann Thorac Surg. 2022 Sep;114(3):785-798. (PMID: 35122722); N Engl J Med. 2010 May 27;362(21):1980-92. (PMID: 20505177); JAMA Surg. 2023 Apr 1;158(4):e228127. (PMID: 36811897); Ann Thorac Surg. 2018 Mar;105(3):851-856. (PMID: 29223416); Eur J Cardiothorac Surg. 2017 Aug 1;52(2):234-240. (PMID: 28444210) |
| Grant Information: | T32 HD094671 United States HD NICHD NIH HHS; UG3 HL166794 United States HL NHLBI NIH HHS |
| Entry Date(s): | Date Created: 20230812 Date Completed: 20231023 Latest Revision: 20231221 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC10729415 |
| DOI: | 10.1016/j.ahj.2023.08.003 |
| PMID: | 37572784 |
| Database: | MEDLINE |
Journal Article; Research Support, N.I.H., Extramural