Factors Affecting Length of Postoperative Hospitalization for Pediatric Cardiac Operations in a Large North American Registry (1982–2007)

Abstract

Introduction Surgical treatment of congenital heart disease represents a major cause of pediatric hospitalization and healthcare resource use. Larger centers may provide more efficient care with resulting shorter length of postoperative hospitalization (LOH). Materials and Methods Data from 46 centers over 25 years was used to evaluate whether surgical volume was an important determinant of LOH using a competing risk regression strategy that concurrently accounted for deaths, transfers, and discharges with some time interactions. Results Earlier discharge was more likely for infants and older children compared to neonates (subhazard ratios at post-operative day 6 of 1.64 [99% confidence interval (CI): 1.57, 1.72] and 2.67 [99% CI: 2.53, 2.80], respectively), but less likely for patients undergoing operations in Risk Adjustment for Congenital Heart Surgery categories 2, 3, 4, and 5&6 compared to category 1 (subhazard ratios at post-operative day 6 of 0.66 [99% CI: 0.64, 0.68], 0.34 [95% CI: 0.33, 0.35], 0.28 [99% CI:0.27, 0.30], and 0.10 [99% CI: 0.09, 0.11], respectively). There was no difference by sex (non-time dependent subhazard ratio 1.019 [99%CI: 0.995, 1.040]). For every 100-unit increase in center annual surgical volume, the non-time dependent subhazard for discharge was 1.035 (99%CI: 1.006, 1.064) times greater and center-specific exponentiated random effects ranged from 0.70 to 1.42 with a variance of 0.023. Discussion The conditional discharge rate increased with increasing age and later era. No sex-specific difference was found. Centers performing more operations discharged patients sooner than lower volume centers but this difference appears to be too small to be of clinical significance. Interestingly, unmeasured institutional characteristics estimated by the center random effects were variable suggesting that these played an important role in LOH and merit further investigation.

Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease

“…(Ann Thorac Surg 2018;106:1234-40) Ó 2018 by The Society of Thoracic Surgeons A lthough advances in surgical management of congenital heart disease (CHD) have substantially improved overall patient outcomes [1,2], CHD remains responsible for the largest proportion of infant and childhood mortality secondary to birth defects in the United States [3]. Numerous studies have been undertaken to identify institutional and patient characteristics that affect outcomes after surgical repair or palliation of CHD [1,[4][5][6]. These studies have shown that younger age and smaller size [7], presence of a genetic syndrome [8], and complexity of surgical repair [1] are all associated with worse outcomes after cardiac operation.…”

“…Numerous studies have been undertaken to identify institutional and patient characteristics that affect outcomes after surgical repair or palliation of CHD [1,[4][5][6]. These studies have shown that younger age and smaller size [7], presence of a genetic syndrome [8], and complexity of surgical repair [1] are all associated with worse outcomes after cardiac operation. Despite these findings, much remains unknown about other factors that affect morbidity and mortality after repair or palliation of CHD.…”

Clinical Databases and Registries in Congenital and Pediatric Cardiac Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide

“…29,30 The PCCC, which no longer enrolls new patients, has been utilized to successfully receive grant funding to examine long-term outcomes in these patients and continues to be a source of publications on a variety of topics. [31][32][33] Inter-Database Communication Progress on facilitating mechanisms for all of these various databases to communicate with one another is continuing to evolve rapidly. [21][22][23][24][25][26][27] Within a given hospital system, one may observe separate specialties entering redundant data on shared patients.…”

“…29,30 The PCCC, which no longer enrolls new patients, has been utilized to successfully receive grant funding to examine long-term outcomes in these patients and continues to be a source of publications on a variety of topics. 31 –33…”

Prolonged length of stay after surgery for adult congenital heart disease: a single-centre study in a developing country

“…Though there have been numerous studies exploring the factors associated with prolonged length of stay after surgery for CHD in the paediatric population, 13,14 there has been very little published on the adult population undergoing surgery for CHD. Data are particularly scarce for developing countries, such as Pakistan.…”