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Risk Factors for Unanticipated Readmissions During the Interstage: A Report From the National Pediatric Cardiology
Samuel P Hanke1, Brian Joy2, Elise Riddle3
1Cincinnati Children׳s Hospital Medical Center, Cincinnati, Ohio.
Seminars in Thoracic and Cardiovascular Surgery
|April 19, 2017
Summary
Unanticipated interstage readmissions are common in hypoplastic left heart syndrome patients, often due to minor clinical changes. Risk factors like genetic syndromes and center volume influence readmission rates, with significant variation across centers.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Healthcare Quality Improvement
Background:
- Hypoplastic left heart syndrome (HLHS) requires complex surgical palliation.
- The interstage period (between initial palliation and definitive repair) is critical for patient outcomes.
- Unanticipated readmissions during this period impact resource utilization and patient management.
Purpose of the Study:
- To describe unanticipated interstage readmissions in HLHS patients.
- To identify independent risk factors associated with these readmissions.
- To evaluate variations in readmission rates among collaborative centers.
Main Methods:
- Retrospective analysis of 815 HLHS patients from the National Pediatric Cardiology Quality Improvement Collaborative registry (2008-2013).
- Competing risks time to event analyses to determine associations between interstage risk factors and readmission.
- Funnel plots used to examine center variation in readmission rates.
Main Results:
- 66% of HLHS patients experienced unanticipated interstage readmissions.
- Most readmissions (64%) were for minor clinical status changes, not major adverse events.
- Independent risk factors included genetic syndrome, center volume, preoperative ventricular dysfunction, tricuspid regurgitation, circulatory arrest duration, and Hybrid procedure use.
Conclusions:
- Unanticipated interstage readmissions are frequent in HLHS patients, with considerable variation among centers.
- Readmissions are typically short and rarely due to major adverse events.
- Identifying risk factors and understanding center variation can inform quality improvement initiatives.