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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Rehospitalization Following Neonatal Cardiac Surgery: Risk Factors and Outcomes
Amira Soliman1, Sanjeev Aggarwal1, Girija Natarajan1
1Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
Insights
Most children with hypoplastic left heart syndrome (HLHS) and transposition of great arteries (TGA) experience unplanned hospital readmissions, often for respiratory issues. Home-care programs could potentially decrease healthcare use in these patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Healthcare Utilization Studies
Background:
- Hypoplastic left heart syndrome (HLHS) and transposition of great arteries (TGA) are critical congenital heart defects requiring neonatal surgical repair.
- Understanding post-operative healthcare utilization is crucial for managing these complex pediatric conditions.
Purpose of the Study:
- To determine the frequency and reasons for unplanned hospital readmissions.
- To identify the number and indications for emergency room visits in children with HLHS and TGA post-neonatal surgery.
Main Methods:
- Retrospective chart review of pediatric patients with HLHS or TGA who underwent neonatal surgical repair.
- Statistical analyses including chi-square test, t-test, and binary logistic regression were employed.
Main Results:
- The study included 117 children (28 HLHS, 89 TGA) followed for a mean of 4.7 years.
- Unplanned readmissions occurred in 39.3% of children, with respiratory issues being the most common indication (57.5%).
- Emergency room visits were frequent, primarily for minor illnesses (64%) and gastrointestinal problems (13.8%).
Conclusions:
- A significant proportion of children with HLHS and TGA experience unplanned readmissions after neonatal surgery.
- Implementing home-care surveillance programs may be beneficial in reducing healthcare utilization for these patients.
Objective:
The aim of the study is to determine the number and indications of unplanned hospital readmissions and emergency room visits for children with hypoplastic left heart syndrome (HLHS) or transposition of great arteries (TGA).
Design:
This retrospective chart review involved children with HLHS or TGA who underwent neonatal surgical repair in a single Children's Hospital. Statistical analysis (SPSS 22.0) included chi-square test, t-test, and binary logistic regression.
Results:
Our study cohort (n=117) comprised 28 children with HLHS and 89 with TGA who were followed for a mean (standard deviation, SD) duration of 4.7 (3.2) years. Unplanned readmissions (n=153) occurred in 46 (39.3%) children, a mean (SD) number of 1.3 (2.8) for a median (interquartile range, IQR) of 8 (2-28) days per patient. Indications were respiratory (57.5%), gastrointestinal (18.3%), and cardiac (12.4%) in nature. On binary regression, with birth weight, race, and gestational age as covariates, among children with HLHS, increasing gestational age tended to be associated with a lower risk of readmissions (odds ratio [OR] 0.138; 95% confidence interval [CI]: 0.018-1.031, p=0.054]. The mean (SD) number of emergency room visits (n=261) was 3.2 (9.7) in 42 (35.9%) infants for minor illnesses (64%) or gastrointestinal (13.8%) problems.
Conclusion:
The majority of children with HLHS and TGA have unplanned readmissions. Home-care surveillance programs may reduce health-care utilization in this population.
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