Predictors of Prolonged Length of Intensive Care Unit Stay After Stage I Palliation: A Report from the National Pediatric Cardiology Quality Improvement Collaborative

Abstract

The objective of this study is to identify predictors of prolonged intensive care unit (ICU) length of stay (LOS) for single ventricle patients following Stage I palliation. We hypothesize that peri-operative factors contribute to prolonged ICU stay among children with hypoplastic left heart syndrome (HLHS) and its variants. In 2008, as a part of the Joint Council on Congenital Heart Disease initiative, the National Pediatric Cardiology-Quality Improvement Collaborative established a data registry for patients with HLHS and its variants undergoing staged palliation. Between July 2008 and August 2011, 33 sites across the United States submitted discharge data essential to this analysis. Data describing the patients, their procedures, and their hospital experience were entered. LOS estimates were generated. Prolonged LOS in the ICU was defined as stay greater than or equal to 26 days (i.e., 75th percentile). Statistical analyses were carried out to identify pre-operative, operative, and post-operative predictors of prolonged LOS in the ICU. The number of patients with complete discharge data was 303, and these subjects were included in the analysis. Univariate and multivariate analyses were performed. Multivariate analysis revealed that lower number of enrolled participants (e.g., 1-10) per site, the presence of pre-operative acidosis, increased circulatory arrest time, the occurrence of a central line infection, and the development of respiratory insufficiency requiring re-intubation were associated with prolonged LOS in the ICU. Prolonged LOS in the ICU following Stage I palliation in patients with HLHS and HLHS variant anatomy is associated with site enrollment, circulatory arrest time, pre-operative acidosis, and some post-operative complications, including central line infection and re-intubation. Further study of these associations may reveal strategies for reducing LOS in the ICU following the Norwood and Norwood-variant surgeries.

Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

“…Younger age, lower weight, heart failure, higher VIS, pulmonary hypertension, delayed sternal closure, greater severity of illness at post-operative admission, BUN, nitric oxide treatment, tracheobronchomalacia, peritoneal dialysis, low cardiac output, health-care associated infections, and noninfectious pulmonary complications are associated with prolonged intubation in patients undergoing surgery for CHD [20] [21] [22] [23]. Premature extubation with the need for reintubation is associated with longer ICU LOS [24]. In our patients, duration of ventilation greater than 20 days was associated with the longest CCU LOS.…”

Catheter‐associated bloodstream infection incidence and outcomes in congenital cardiac surgery

“…Additionally, it has been shown that CABSI can prolong length of stay (LOS) by up to 24 days . Prior studies have shown that each additional hospital day after surgery costs approximately $500 . While CABSI is definitively prevented by not having central access, this is not always possible, and studies have highlighted the importance of standardized methods for prevention …”

“…3 Prior studies have shown that each additional hospital day after surgery costs approximately $500. 4 While CABSI is definitively prevented by not having central access, this is not always possible, and studies have highlighted the importance of standardized methods for prevention. 5 There are limited published data on the incidence of CABSI in children with congenital heart disease undergoing congenital cardiac surgery (CCS).…”

Deep Learning for Improved Risk Prediction in Surgical Outcomes

“…Few LOS models have been developed for children or infants undergoing cardiac surgery, although the pediatric heart network investigators 18,19 have reported on risk factors for prolonged length of stay following the Glenn and Fontan procedures. Currently, there is no precise definition of prolonged length of stay in the literature, but previous studies using the PHN SVR dataset have used a threshold at the 75th percentile 20,21 . Schwartz et al 18 defined prolonged LOS after Norwood as the median length of stay for transplant-free survivors who later underwent Glenn procedure.…”