Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery.
| Title: | Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery. |
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| Authors: | Prabhu NK; Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Moya-Mendez ME; Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Kang L; Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Medina CK; Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA.; McCrary AW; Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA.; Allareddy V; Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA.; Overbey D; Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA.; Turek JW; Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA.; Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA. |
| Source: | World journal for pediatric & congenital heart surgery [World J Pediatr Congenit Heart Surg] 2024 May; Vol. 15 (3), pp. 303-312. Date of Electronic Publication: 2024 Jan 23. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Sage Publications Country of Publication: United States NLM ID: 101518415 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2150-136X (Electronic) Linking ISSN: 21501351 NLM ISO Abbreviation: World J Pediatr Congenit Heart Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Thousand Oaks, CA : Sage Publications |
| MeSH Terms: | Heart Defects, Congenital*/surgery ; Heart Defects, Congenital*/mortality ; Heart Ventricles*/surgery ; Heart Ventricles*/abnormalities ; Fontan Procedure*/mortality ; Fontan Procedure*/methods; Heart Bypass, Right/mortality ; Univentricular Heart/surgery ; Univentricular Heart/mortality ; Humans ; Retrospective Studies ; Female ; Male ; Infant ; Child, Preschool ; Treatment Outcome |
| Abstract: | Background: To develop a more holistic measure of congenital heart center performance beyond mortality, we created a composite "textbook outcome" (TO) for the Glenn operation. We hypothesized that meeting TO would have a positive prognostic and financial impact. Methods: This was a single center retrospective study of patients undergoing superior cavopulmonary connection (bidirectional Glenn or Kawashima ± concomitant procedures) from 2005 to 2021. Textbook outcome was defined as freedom from operative mortality, reintervention, 30-day readmission, extracorporeal membrane oxygenation, major thrombotic complication, length of stay (LOS) >75th percentile (17d), and mechanical ventilation duration >75th percentile (2d). Multivariable logistic regression and Cox proportional hazards modeling were used. Results: Fifty-one percent (137/269) of patients met TO. Common reasons for TO failure were prolonged LOS (78/132, 59%) and ventilator duration (67/132, 51%). In multivariable analysis, higher weight [odds ratio, OR: 1.44 (95% confidence interval, CI: 1.15-1.84), P = .002] was a positive predictor of TO achievement while right ventricular dominance [OR 0.47 (0.27-0.81), P = .007] and higher preoperative pulmonary vascular resistance [OR 0.58 (0.40-0.82), P = .003] were negative predictors. After controlling for preoperative factors and excluding operative mortalities, TO achievement was independently associated with a decreased risk of death over long-term follow-up [hazard ratio: 0.50 (0.25-0.99), P = .049]. Textbook outcome achievement was also associated with lower direct cost of care [$137,626 (59,333-167,523) vs $262,299 (114,200-358,844), P |
| Competing Interests: | Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Contributed Indexing: | Keywords: CHD; Glenn; congenital heart surgery; hypoplastic left heart syndrome; morbidity; mortality; univentricular heart |
| Entry Date(s): | Date Created: 20240124 Date Completed: 20240516 Latest Revision: 20240611 |
| Update Code: | 20260130 |
| DOI: | 10.1177/21501351231215261 |
| PMID: | 38263731 |
| Database: | MEDLINE |
Journal Article