Impact of preoperative location on outcomes in congenital heart surgery
Punkaj Gupta1, Brandon W Beam1, Tommy R Noel1
1Division of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Insights
Infants with congenital heart disease had worse outcomes when cared for in a neonatal ICU (NICU) versus a cardiovascular ICU (CVICU) before surgery. This suggests preoperative location may influence results in pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery Outcomes
- Neonatal Intensive Care
Background:
- Limited understanding of how preoperative care location affects outcomes in infants with congenital heart disease (CHD).
- Evaluating morbidity and mortality differences between neonatal intensive care units (NICUs) and cardiovascular intensive care units (CVICUs) for infants undergoing cardiac surgery.
Purpose of the Study:
- To assess the impact of preoperative care location (NICU vs. CVICU) on morbidity and mortality in infants undergoing cardiac surgery for CHD.
- To compare outcomes between infants cared for in NICUs versus CVICUs prior to multi-institutional cardiac surgery.
Main Methods:
- Utilized data from the Pediatric Health Information System (PHIS), a multicenter, national dataset (2004-2013).
- Included infants aged 0-45 days undergoing CHD surgery (with or without cardiopulmonary bypass).
- Employed propensity score matching to create comparable NICU and CVICU patient cohorts based on demographics and preoperative characteristics.
Main Results:
- Analysis included 5,376 patients from 20 hospitals; 2,456 were matched 1:1 between NICU and CVICU groups.
- Significantly higher mortality (11.9% vs. 8.8%), longer preoperative and total hospital length of stay (LOS), and more mechanical ventilation days were observed in the NICU group.
- No significant difference in mortality was found for low-complexity operations or for patients treated at high-volume hospitals.
Conclusions:
- Preoperative care location may be a significant factor influencing outcomes in infants undergoing cardiac surgery for CHD.
- The observed differences may be influenced by unmeasured factors, suggesting preoperative location could be a surrogate.
- Further research is necessary to fully elucidate the relationship between preoperative care setting and patient outcomes.
Background:
Little is known about the impact of preoperative location on outcomes in infants undergoing cardiac surgery for congenital heart disease. This study was designed to evaluate the morbidity and mortality among infants who were cared for in a neonatal ICU (NICU) versus dedicated cardiovascular intensive care unit (CVICU) prior to cardiac surgery in a multi-institutional population.
Methods:
Data were obtained from a multicenter, administrative, national dataset, Pediatric Health Information System (PHIS). Patients 0 to 45 days undergoing surgery for congenital heart disease (with or without cardiopulmonary bypass) at a PHIS-participating hospital (2004 to 2013) were included. Propensity score matching was performed to match the NICU and the CVICU patients with similar demographic and preoperative clinical characteristics.
Results:
A total of 5,376 patients from 20 hospitals met inclusion criteria. By propensity score matching, 2,456 patients matched 1 to 1 between the NICU and the CVICU groups. Outcomes including mortality (NICU vs CVICU, 11.9% vs 8.8%, p < 0.001), preoperative and total hospital length of stay (LOS), and total length of mechanical ventilation were significantly greater among the NICU patients compared with the CVICU patients. There was no significant difference in mortality among the patients undergoing "low" complexity operations (NICU vs CVICU, 8.4% vs 6.7%, p = 0.22), and patients undergoing treatment at high volume hospitals (NICU vs CVICU, 9.6% vs 9.5%, p = 0.95).
Conclusions:
This study demonstrates that preoperative location might impact outcomes in children undergoing operation for congenital heart disease. It is possible that preoperative location may be surrogate for other factors that may bias the results. Further study is warranted.
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