Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

Abstract

BackgroundWe sought to identify patient and surgical factors associated with time to hospital discharge in patients undergoing complete repair for tetralogy of Fallot.Methods and ResultsWe performed a prospective cohort study of patients with tetralogy of Fallot admitted for complete repair between May 1, 2012 and June 2, 2017 at Children's Hospital of Philadelphia with detailed demographic, clinical, and operative characteristics. The primary outcome was time to hospital discharge. Cox proportional hazards models were used to identify patient and operative predictors of time to hospital discharge. We enrolled 151 subjects, 62.8% male, 65.6% non‐Hispanic white, and 9.9% non‐Hispanic black. The median time to hospital discharge was 7 days (interquartile range 4, 12). Five patients died in the hospital, all of whom underwent tetralogy of Fallot repair beyond the neonatal period. Greater birth weight was associated with higher rate of hospital discharge (hazard ratio [HR]=1.35, 95% confidence interval (CI) =1.11, 1.64), while absent pulmonary valve versus pulmonary stenosis (HR=0.27, 95% CI=0.08, 0.91), pulmonary valve atresia versus pulmonary stenosis (HR=0.57, 95% CI=0.33, 0.97), presence of aortopulmonary collaterals (HR=0.44, 95% CI=0.24, 0.84), complete repair performed in the neonatal period (<30 days of life) (HR=0.45, 95% CI=0.27, 0.75), more than 1 cardiopulmonary bypass run (HR=0.33, 95% CI=0.18, 0.61), and longer aortic cross‐clamp time (HR [per 10 minutes]=0.88, 95% CI=0.79, 0.97) were associated with lower rate of hospital discharge.ConclusionsPostoperative hospital stay after complete repair of tetralogy of Fallot is in part determined by patient and operative factors. Some (eg, surgical strategy for the symptomatic neonate) may be modifiable. These results may impact patient counseling, choice of surgical approach, and postoperative care.

Predictors of a complicated course after surgical repair of tetralogy of Fallot

“…In the literature, the LOHS after TOF surgical repair has been reported as six to eight days. [2,3,[9][10][11] In our study, the mean LOHS was found to be eight (range, 1.0 to 40.0) days. In a prospective study of 151 patients evaluating the factors affecting hospital stay after TOF surgical treatment, birth weight, absence or atresia of the pulmonary valve, presence of MAPCA, institution of CPB more than once, duration of arterial cross-clamp (ACC), use of circulatory arrest, neonatal repair, and the lowest hematocrit during CPB were shown to be predictors of hospital stay.…”

“…Pulmonary annulus Z-score and operation age did not affect the hospital stay. [3] In another study, comorbid factors such as preoperative renal failure, preoperative neurological deficits, and preoperative MV dependence prolonged LOHS. [12] Kirsch et al [13] also reported that the development of low weight, chromosomal abnormalities, and complications were associated with prolonged LOHS.…”

“…Major adverse events included complete atrioventricular (AV) block requiring pacemaker implantation, renal failure, diaphragmatic paralysis, neurological deficit, unplanned reoperation due to residual lesions, sudden circulatory arrest, need for postoperative mechanical circulation support, or death. [3] Complications except for MAEs were defined as pulmonary complications (i.e., atelectasis, pneumothorax, hemothorax, or pleural effusion), re-intubation, arrhythmia (junctional ectopic tachycardia [JET], temporary complete AV block, infection (except for superficial wound infection), wound infections, development of restrictive physiology, delayed sternal closure, post-pericardiotomy syndrome, chylothorax, and rehospitalization (within 30 days postoperatively). Restrictive physiology diagnosis was made in the early postoperative period after the detection of end-diastolic forward flow on echocardiographs in patients with low cardiac output and a need for inotropic drugs.…”

“…A MV duration of >24 h, ICU duration of >3 days, and hospital stay of >7 days were considered as prolonged. [1][2][3][8][9][10][11] The patients were divided into two groups according to the LOHS (shorter and longer than seven days) and age (under one year and older).…”

“…[1,2] However, there are still risks of a complicated course from heart block, reoperation due to residual defects, and prolonged hospital stays. [3] The length of hospital stay (LOHS) is an important surgical outcome and is associated with long-term results, such as the neurodevelopmental outcomes. [4,5] There are also reports that prolonged hospital stay is associated with long-term adverse events.…”