Impact of Confounding on Cost, Survival, and Length-of-Stay Outcomes for Neonates with Hypoplastic Left Heart Syndrome Undergoing Stage 1 Palliation Surgery

Gong, Chen; Song, Ashley; Horak, Robin; Friedlich, Philippe; Lakshmanan, Ashwini; Pruetz, Jay D.; Yieh, Leah; Kumar, S. Ram; Williams, Roberta G.

doi:10.1007/s00246-020-02348-5

Cited by 11 publications

(16 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cost of HLHS management continues to be determined by complications such as reoperation, the need of extracorporeal membrane oxygenation (ECMO), and patient factors such as low birth-weight [ 28 ]. Recently published multicenter data [ 29 ] showed an analysis of 2872 Norwood records in HLHS over a five-year period between 2003 and 2016. Mortality decreased from 28 to 14%, although the incidence of ECMO increased from 10% to 17.3%.…”

Section: Traditional Norwood Stage-i Palliation and Follow-up Resultsmentioning

confidence: 99%

Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

2021

View full text Add to dashboard Cite

The hypoplasia of left-sided heart structures shows great variability and complexity. What the many variants have in common is that their heart structures are neither fully developed before nor after birth. Fetuses and newborns require an individual therapy depending on anatomy and function of the heart. Fetal interventions focus on improving left heart structures by catheter-based interventions and maternal hyperoxygenation which promotes growth as the left ventricular preload and blood flow within the cavity increase. Stage-I management of newborns with single ventricle physiology is usually based on the Norwood/Sano surgery or the Hybrid approach. Two more steps are required to ultimately achieve a Fontan circulation. Some centers also use the Hybrid approach for subsequent Norwood operation beyond the neonatal period. After the Hybrid approach, a comprehensive stage-II or corrective surgery is performed, the latter if a bi-ventricular circulation is possible. With progressively improved catheter-based interventions, particularly ductal stenting and manipulations of the atrial septum, the next advance is to develop a bespoke flow restrictor that can be easily inserted into the branches of the pulmonary artery. The main goal is to avoid complex heart operations under general anesthesia, followed by substantial intensive care in the neonatal period, especially for patients with complex heart defects. Based on the current state of the art of surgical treatment of hypoplastic left heart syndrome and variants with the Norwood surgery or the Hybrid approach, our main focus is on an alternative percutaneous transcatheter technique in the sense of a completely non-surgical stage-I approach.

show abstract

Section: Traditional Norwood Stage-i Palliation and Follow-up Resultsmentioning

confidence: 99%

Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

2021

View full text Add to dashboard Cite

show abstract

“…This center performed 113 Norwood procedures over 15 years (7.5 Norwood operations and a total of 145 cardiac surgical procedures per year on average), qualifying it by some as a lower volume program. 23,24 The positive association between volume and Norwood outcomes has been demonstrated in several studies. 5,6,23,24 However, our analysis shows anecdotally that lower volume programs can ideally achieve Norwood survival outcomes similar to those of large-volume centers.…”

Section: Commentmentioning

confidence: 90%

“…23,24 The positive association between volume and Norwood outcomes has been demonstrated in several studies. 5,6,23,24 However, our analysis shows anecdotally that lower volume programs can ideally achieve Norwood survival outcomes similar to those of large-volume centers.…”

Section: Commentmentioning

confidence: 90%

Outcomes Following Norwood Procedures: Analysis of a “Small Volume” Program

D’Angelo

Narasimhulu

Pourmoghadam

et al. 2022

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background Institutional survival following Norwood procedures is traditionally correlated with a center's surgical volume. Multiple single and multi-institutional studies conducted at large-volume centers have recently demonstrated improved survival following Norwood procedures. We report both short- and long-term outcomes at a single, small-volume institution and comment on factors potentially influencing outcomes at this institution. Methods All patients undergoing Norwood procedures from January 1, 2005, to January 1, 2020, at our institution were included in this study. Kaplan-Meier survival and Cox regression risk factor analyses were performed in addition to first interstage risk factor scoring to compare observed versus expected survival. Results The cohort included 113 patients. Kaplan-Meier freedom from death or transplant was 88%, 80%, and 76% at 1, 5, and 10 years, respectively. Freedom from death following hospital discharge after Norwood procedures was 94%, 87%, and 83% at 1, 5, and 10 years, respectively. The presence of genetic syndromes was a significant risk factor for mortality. First interstage observed-to-expected mortality following discharge was 0.57 ( P = .04). Postoperative length of stay was comparable to that reported for the period 2015 to 2018 in the Society of Thoracic Surgeons Database. Conclusions Survival outcomes at this single, small-volume institution were similar to those reported by large-volume centers and multi-institutional collaborative studies. These results may be related to structural and functional features that have been demonstrated to influence outcomes in other studies. These factors are achievable by small-volume programs with sufficient resource allocation.

show abstract

“…We also conducted an E-value analysis for the quality of life outcomes, which is a type of sensitivity analysis that quantifies unmeasured confounding to determine whether unmeasured confounding may have contributed to the observed effects [28]. As detailed in previous work conducted by our group [29], the E-value analysis addresses the extent to which unmeasured confounding may negate the observed results. A relatively low E-value in the context of statistical adjustments made suggests that the results could easily be nullified by a confounder.…”

Section: Discussionmentioning

confidence: 99%

“…A relatively low E-value in the context of statistical adjustments made suggests that the results could easily be nullified by a confounder. Conversely, a very high E-value relative to the point estimate may imply that the observed effect is in fact plausible, because the strength and association of the unmeasured confounder with the exposure group and outcome must be very high to negate the observed effect [29].…”

Section: Discussionmentioning

confidence: 99%

Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study

Gateau

Song

Vanderbilt

et al. 2021

BMC Pregnancy Childbirth

Self Cite

View full text Add to dashboard Cite

Background Having a preterm newborn and the experience of staying in the neonatal intensive care unit (NICU) has the potential to impact a mother’s mental health and overall quality of life. However, currently there are few studies that have examined the association of acute post-traumatic stress (PTS) and depression symptoms and infant and maternal outcomes in low-income populations. Design/ methods In a cross-sectional study, we examined adjusted associations between positive screens for PTS and depression using the Perinatal Post-traumatic stress Questionnaire (PPQ) and the Patient Health-Questionnaire 2 (PHQ-2) with outcomes using unconditional logistic and linear regression models. Results One hundred sixty-nine parents answered the questionnaire with 150 complete responses. The majority of our sample was Hispanic (68%), non-English speaking (67%) and reported an annual income of <$20,000 (58%). 33% of the participants had a positive PPQ screen and 34% a positive PHQ-2 screen. After adjusting for confounders, we identified that a positive PHQ-2 depression score was associated with a negative unit (95% CI) change on the infant’s Vineland Adaptive Behavior Scales, second edition of − 9.08 (− 15.6, − 2.6) (p < 0.01). There were no significant associations between maternal stress and depression scores and infant Bayley Scales of Infant Development III scores or re-hospitalizations or emergency room visits. However, positive PPQ and screening score were associated with a negative unit (95% CI) unit change on the maternal Multicultural Quality of Life Index score of − 8.1 (− 12, − 3.9)(p < 0.01) and − 7.7 (− 12, − 3) (p = 0.01) respectively. Conclusions More than one-third of the mothers in this sample screened positively for PTS and depression symptoms. Screening scores positive for stress and depression symptoms were associated with a negative change in some infant development scores and maternal quality of life scores. Thoughtful screening programs for maternal stress and depression symptoms should be instituted.

show abstract

Impact of Confounding on Cost, Survival, and Length-of-Stay Outcomes for Neonates with Hypoplastic Left Heart Syndrome Undergoing Stage 1 Palliation Surgery

Cited by 11 publications

References 44 publications

Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon

Outcomes Following Norwood Procedures: Analysis of a “Small Volume” Program

Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study

Contact Info

Product

Resources

About