Center Variation in Chest Tube Duration and Length of Stay After Congenital Heart Surgery

Bates, Katherine E.; Madsen, Nicolas; Khadr, Lara; Gao, Zhiqian; Crawford, Kari; Gaies, Michael; Graupe, Margaret; Hanke, Samuel P.; Hlavacek, Anthony M.; Morell, Evonne; Pasquali, Sara K.; Russell, Jennifer; Schachtner, Susan; Tanel, Ronn E.; Ware, Adam L.; Kipps, Alaina K.

doi:10.1016/j.athoracsur.2019.09.078

Cited by 15 publications

(7 citation statements)

References 19 publications

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“…In the first paper, the group reported the results of a program to quantify intercenter variability in chest tube management practices in 1,029 congenital cardiac surgery patients at 9 centers. 80 They found that the center with the most favorable outcomes had chest tube durations that were 27.9% to 87.4% shorter in duration than the other centers across 9 of 10 benchmark operations ( P < 0.001 in multivariable analysis). Meanwhile, despite higher median chest tube output volume before removal (8.5 vs 2.2 mL/kg/24 h, P < 0.001), patients at that center did not experience higher rates of chest tube reinsertion or readmission for pleural effusion.…”

Section: Discussionmentioning

confidence: 97%

Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices

Lobdell¹,

Engelman

2023

Innovations�(Phila)

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In the field of modern cardiothoracic surgery, chest drainage has become ubiquitous and yet characterized by a wide variation in practice. Meanwhile, the evolution of chest drain technology has created gaps in knowledge that represent opportunities for new research to support the development of best practices in chest drain management. The chest drain is an indispensable tool in the recovery of the cardiac surgery patient. However, decisions about chest drain management—including those about type, material, number, maintenance of patency, and the timing of removal—are largely driven by tradition due to a scarcity of quality evidence. This narrative review surveys the available evidence regarding chest-drain management practices with the objective of highlighting scientific gaps, unmet needs, and opportunities for further research.

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Section: Discussionmentioning

confidence: 97%

Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices

Lobdell¹,

Engelman

2023

Innovations�(Phila)

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“…Standardization of therapy has been shown previously to improve patient care [9,10]. With the creation of the PAC 3 registry, we plan to assess which AT elements have the highest impact on reducing LOS, minimizing complications, decreasing return admissions to the intensive care unit, and [11].…”

Section: Discussionmentioning

confidence: 99%

High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys

et al. 2021

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We utilized the multicenter Pediatric Acute Care Cardiology Collaborative (PAC 3 ) 2017 and 2019 surveys to describe practice variation in therapy availability and changes over a 2-year period. A high acuity therapies (ATs) score was derived (1 point per positive response) from 44 survey questions and scores were compared to center surgical volume. Of 31 centers that completed the 2017 survey, 26 also completed the 2019 survey. Scores ranged from 11 to 34 in 2017 and 11 to 35 in 2019. AT scores in 2019 were not statistically different from 2017 scores (29/44, IQR 27–32.5 vs. 29.5/44, IQR 27–31, p = 0.9). In 2019, more centers reported initiation of continuous positive airway pressure (CPAP) and Bi-level positive airway pressure (BiPAP) in Acute Care Cardiology Unit (ACCU) (19/26 vs. 4/26, p < 0.001) and permitting continuous CPAP/BiPAP (22/26 vs. 14/26, p = 0.034) compared to 2017. Scores in both survey years were significantly higher in the highest surgical volume group compared to the lowest, 33 ± 1.5 versus 25 ± 8.5, p = 0.046 and 32 ± 1.7 versus 23 ± 5.5, p = 0.009, respectively. Variation in therapy within the ACCUs participating in PAC 3 presents an opportunity for shared learning across the collaborative. Experience with PAC 3 was associated with increasing available respiratory therapies from 2017 to 2019. Whether AT scores impact the quality and outcomes of pediatric acute cardiac care will be the subject of further investigation using a comprehensive registry launched in early 2019.

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“…[ 21 ] In our single-ventricle patients after Glenn and Fontan procedures, we maintain diuretics at a minimum of every 8 h, supplemental oxygen of 1 liter nasal cannula FiO 2 100% while chest tubes are in place (regardless of oxygen saturation), and remove chest tubes when there is drainage of < 6 cc/kg/tube over any 24 h period with no radiographic evidence of significant pleural effusions. [ 22 23 ] Patients are discharged home on oral diuretics often every 8 h, with a follow-up chest X-ray with their primary cardiologist 2–3 days postdischarge.…”

Section: Methodsmentioning

confidence: 99%

“… General postoperative management of chest tubes, diuretics and diet after Fontan at our institution. [ 21 22 23 ] CT: Chest tube; L: Liter; NC: Nasal cannula; POD: Postoperative day; TPN: Total parenteral nutrition …”

Section: Methodsmentioning

confidence: 99%

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

et al. 2020

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Objective: To investigate patient-related factors, echocardiographic, and anatomic variables associated with immediate and long-term clinical outcomes after extracardiac Fontan procedure at our institution. Materials and Methods: Retrospective review of preoperative cardiac catheterizations and echocardiograms as well as medical records of all children with hypoplastic left heart syndrome (HLHS) who underwent Fontan between June 2002 and December 2018. Results: Seventy-seven patients with HLHS were included (age 4 years [1.5–11.7]). Seventy patients (91%) received a nonfenestrated Fontan and 57 patients (74%) underwent Fontan without cardiopulmonary bypass (CPB). Presence of a Fontan fenestration ( P = 0.69) and use of CPB ( P = 0.79) did not differ between those with <2 weeks compared to those with ≥2 weeks of chest tube drainage. There were no differences in either pre- or intra-operative hemodynamics between patients who weighed <15 kg compared to those who weighed ≥15 kg at time of surgery; incidence of death, transplant, and transplant listing were similar between weight groups. Inferior vena cava (IVC) diameter z-score did not differ among patients with and without chylous chest tube drainage ( P = 0.78), with and without development of protein losing enteropathy ( P = 0.23), or death/heart transplant/transplant listing compared to survivors without transplant ( P = 0.26). Conclusion: In HLHS patients undergoing Fontan, preoperative weight and IVC diameter appeared to have no influence on immediate postoperative outcomes. Performing the Fontan off CPB and with a fenestration also conferred no added clinical benefit. These observations should be considered when deciding optimal timing for Fontan completion.

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Center Variation in Chest Tube Duration and Length of Stay After Congenital Heart Surgery

Cited by 15 publications

References 19 publications

Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices

Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices

High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

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