Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

Abstract

Objectives: We aimed to further validate the vasoactive-ventilation-renal score as a predictor of outcome in patients recovering from surgery for congenital heart disease. We also sought to determine the optimal time point within the early recovery period at which the vasoactive-ventilation-renal score should be measured. Methods: We prospectively reviewed consecutive patients recovering from cardiac surgery within our intensive care unit between January 2015 and June 2015. The vasoactive-ventilation-renal score was calculated at 6, 12, 24, and 48 hours postoperatively as follows: vasoactive-ventilation-renal score ¼ ventilation index þ vasoactive-inotrope score þ D creatinine [change in serum creatinine from baseline*10]. Primary outcome of interest was prolonged hospital length of stay, defined as length of stay in the upper 25%. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling also was performed. Results: We reviewed 164 patients with a median age of 9.25 months (interquartile range, 2.6-58 months). Median length of stay was 8 days (interquartile range, 5-17.5 days). The area under the curve value for the vasoactive-ventilation-renal score as a predictor of prolonged length of stay (>17.5 days) was greatest at 12 hours postoperatively (area under the curve ¼ 0.93; 95% confidence interval, 0.89-0.97). On multivariable regression analysis, after adjustment for potential confounders, the 12-hour vasoactive-ventilation-renal score remained a strong predictor of prolonged hospital length of stay (odds ratio, 1.15; 95% confidence interval, 1.10-1.20). Conclusions: In a heterogeneous population of patients undergoing surgery for congenital heart disease, the novel vasoactive-ventilation-renal score calculated in the early postoperative recovery period can be a strong predictor of prolonged hospital length of stay.

Multicenter Validation of the Vasoactive-Ventilation-Renal Score as a Predictor of Prolonged Mechanical Ventilation After Neonatal Cardiac Surgery*

“…In the most recent single center VVR study, a VVR score greater than 25 was identified as the best cutoff point distinguishing between children who were at risk for poor postoperative outcome and children who were not (10). Not surprisingly, in a cohort of patients that included only neonates, who tend to be more complex (i.e.…”

“…The vasoactive-ventilation-renal (VVR) score is a novel disease severity index that incorporates validated markers of cardiovascular, pulmonary, and renal function. In single center studies, it has been shown to be a robust predictor of outcomes in heterogenous populations of children recovering from surgery for congenital heart disease (8)(9)(10). These studies have included neonates (8)(9)(10), children with cyanotic congenital heart disease (9)(10), children undergoing cardiopulmonary bypass (8)(9)(10), children not undergoing cardiopulmonary bypass (9)(10), and adults with congenital heart disease (10).…”

“…In single center studies, it has been shown to be a robust predictor of outcomes in heterogenous populations of children recovering from surgery for congenital heart disease (8)(9)(10). These studies have included neonates (8)(9)(10), children with cyanotic congenital heart disease (9)(10), children undergoing cardiopulmonary bypass (8)(9)(10), children not undergoing cardiopulmonary bypass (9)(10), and adults with congenital heart disease (10). Most recently, the VVR score obtained at 12 hours postoperatively was shown to be a strong predictor of postoperative hospital length of stay and outperformed more traditional indices of disease complexity and illness severity including STAT mortality category, duration of cardiopulmonary bypass, vasoactive-inotrope score, ventilation index, and serum lactate (10).…”

The effect of Vasoactive- ventilation- renal score on pediatric heart surgery

“…genital heart disease group during their pediatric ICU stay [3][4][5]. The basic desired features of all these scoring systems are to build a reliable system that is available in common and decrease ICU costs, the efficient use of the sources, to be guiding in clinical decisions and practices and allow objective evaluation.…”

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

“…Prospective validation by Miletic and colleagues in a heterogeneous population of pediatric patients undergoing cardiac surgery found the 48-h VVR score to be a predictor of outcomes and outperformed VIS [3]. Prolonged hospital LOS was predicted by the VVR at 12 hours in another prospective study by Scherer et al of a heterogeneous population of patients undergoing congenital heart surgery [4]. Multicenter validation of the score in neonatal cardiac surgery is ongoing [5].…”