Standardization of the Norwood Procedure Improves Outcomes in a Medium-Sized Volume Center.
| Title: | Standardization of the Norwood Procedure Improves Outcomes in a Medium-Sized Volume Center. |
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| Authors: | Hampton Gray W; Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.; Sorabella RA; Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.; Moellinger AB; Division of Pediatric Cardiology, Department of Pediatrics, Section of Cardiac Critical Care, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA.; Zaccagni H; Division of Pediatric Cardiology, Department of Pediatrics, Section of Cardiac Critical Care, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA.; Padilla LA; Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.; Santiago B; Division of Pediatric Cardiology, Department of Pediatrics, Section of Cardiac Critical Care, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA.; Sindelar M; Department of Cardiovascular Perfusion, Children's of Alabama, Birmingham, AL, USA.; Dabal RJ; Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. |
| Source: | World journal for pediatric & congenital heart surgery [World J Pediatr Congenit Heart Surg] 2024 Nov; Vol. 15 (6), pp. 738-745. Date of Electronic Publication: 2024 Jun 10. |
| 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: | Norwood Procedures*/standards ; Hypoplastic Left Heart Syndrome*/surgery; Length of Stay/statistics & numerical data ; Humans ; Female ; Male ; Infant, Newborn ; Retrospective Studies ; Treatment Outcome ; Alabama |
| Abstract: | The Norwood operation has become common practice to palliate patients with hypoplastic left heart structures. Surgical technique and postoperative care have improved; yet, there remains significant attrition prior to stage II palliation. The objective of this study is to report outcomes before and after standardizing our approach to the Norwood operation. Patients who underwent the Norwood operation at Children's of Alabama were identified, those who underwent hybrid palliation operations were excluded. Pre- (2015-2020) and post- (2020-January 2023) standardization groups were compared and outcomes analyzed. Ninety-one patients were included (pre-standardization 44 (48.3%) and 47 (51.7%) post-standardization). There were no differences in baseline and intraoperative characteristics at Norwood between the pre- and post-standardization groups. Compared with pre-standardization, post-standardization was associated with decreased time to extubation (OR 0.87, 95%CI 0.79-0.96), inotrope duration (OR 0.92, 95%CI 0.86-0.98) and hospital length of stay (OR 0.98, 95%CI 0.96-0.99). There was a trend toward decreased cardiac arrest, reintervention rates, and interstage mortality for the post-standardization group. A standardized approach to complex neonatal cardiac operations such as the Norwood procedure may improve morbidity and decrease hospital resource utilization. We recommend establishing protocols at an institutional level to optimize outcomes in such high-risk patient populations. |
| 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: Norwood procedure; hypoplastic left heart syndrome; morbidity); outcomes (includes mortality; standardization |
| Entry Date(s): | Date Created: 20240610 Date Completed: 20241112 Latest Revision: 20250610 |
| Update Code: | 20260130 |
| DOI: | 10.1177/21501351241249112 |
| PMID: | 38853679 |
| Database: | MEDLINE |
Journal Article