Clinical Outcomes and Resource Use for Infants With Hypoplastic Left Heart Syndrome During Bidirectional Glenn: Summary From the Joint Council for Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative Registry

Abstract

The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry captures information on interstage management of infants with hypoplastic left heart syndrome (HLHS). The purpose of this study was to identify interstage risk factors for increased resource use and adverse outcomes during bidirectional Glenn (BDG) hospitalization. All infants in the NPC-QIC registry (31 United States hospitals) undergoing BDG surgery were included (December 2009 to August 2010). Patient demographics, interstage variables, operative procedures, and complications were recorded. Days of hospitalization, ventilation, inotrope use, and complications were surrogates of resource use. Logistic regression analysis determined the associations between predictor variables and resource use. Of 162 infants, 105 (65 %) were males. At BDG, the median age was 155 days (range 78-128), mean weight-for-age z-score was -1.6 ± 1.1, mean length-for-age z-score was -1.5 ± 1.7, and mean preoperative oxygen saturation was 78 % ± 7 %. Caloric recommendations were met in 60 % of patients, and 85 % of patients participated in a home-surveillance program. Median days of intubation, inotrope use, and hospitalization were 1, 2, and 7, respectively. There were 4 post-BDG deaths and 55 complications. In multivariate analysis, lower weight-for-age z-score, female sex, and aortic atresia with mitral stenosis were associated with a higher risk of BDG complications. Meeting caloric recommendations before BDG was associated with fewer hospitalization days. Lower weight-for-age z-score was an independent and potentially modifiable risk factor for BDG complications. HLHS infants who met caloric recommendations before BDG had a lower duration of hospitalization at BDG. These data justify targeting nutrition in interstage strategies to improve outcomes and decrease costs for patients with HLHS.

Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial

“…The median hospital LOS was 8 days, consistent with several previous single center reports 5–8,12,23–25 , although some series have reported considerably longer LOS ranging from 11 to 21 days 13,26 . Given this wide variability in LOS in the published literature, it is not surprising that there was a significant association of LOS with the surgical center at which the stage II procedure was performed.…”

“…This approach reduces morbidity and mortality at the time of the Fontan procedure 1,2 and is well tolerated Several series suggest the median length of hospital stay (LOS) is 5–7 days and there are relatively few complications 3–8 . Despite the generally excellent results there are a number of preoperative risk factors associated with prolonged LOS, hospital death, or failure of the cavopulmonary circulation to provide adequate oxygenation and/or acceptable hemodynamics.…”

Home monitoring program reduces interstage mortality after the modified Norwood procedure

“…Efforts currently are underway in the multicenter National Pediatric Cardiology Quality Improvement Collaborative to refine predictors of risk for individual patients and to identify specific practices associated with improved interstage survival and lower admission rates. [23][24][25] FIGURE E1. When there were clinical concerns from either the parent or the NP, an action plan was created.…”

Effects of Race, Ethnicity, and Gender on Surgical Mortality in Hypoplastic Left Heart Syndrome

“…Previous studies have shown that lower weight-for-age z -scores increase the risk of complications after S2P [1, 33]. More recently, Anderson et al [2] demonstrated that non-Caucasian races have lower weight-for-age z -scores.…”