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Interstage outcomes in single ventricle patients undergoing hybrid stage 1 palliation
Janet M Simsic1, Christina Phelps1, Kristin Kirchner1
1The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.
Insights
Interstage readmissions are frequent in infants with single ventricle congenital heart disease. Addressing feeding issues and viral bronchiolitis is crucial for improving outcomes and reducing healthcare costs.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Palliation
Background:
- Infants with single ventricle congenital heart disease (SV-CHD) often require staged surgical palliation.
- Interstage readmissions are a significant concern in this vulnerable population.
Purpose of the Study:
- To retrospectively examine the frequency, reasons, and outcomes of interstage readmissions in infants undergoing hybrid stage 1 palliation.
- To identify factors influencing readmissions and interstage mortality.
Main Methods:
- Retrospective analysis of newborns undergoing hybrid stage 1 palliation from January 2012 to December 2016.
- Data collected included reasons for readmission, feeding modality, major adverse events, and interstage mortality.
Main Results:
- 75% of patients experienced 87 interstage readmissions, with 17% due to major adverse events (e.g., cardiac catheterization interventions, stroke, sepsis).
- Gastrointestinal/feeding issues (33), cyanosis (15), and work of breathing (15) were common reasons for readmission.
- Interstage mortality was 7%, and 5% of patients spent over 30 days hospitalized during the interstage period.
Conclusions:
- Interstage readmissions are common in SV-CHD patients post-hybrid stage 1 palliation.
- Major adverse events and feeding difficulties contribute significantly to readmissions.
- Targeted interventions for feeding issues and viral bronchiolitis may improve outcomes and reduce healthcare utilization.
Objective:
Interstage readmissions are common in infants with single ventricle congenital heart disease undergoing staged surgical palliation. We retrospectively examined readmissions during the interstage period.
Design:
Retrospective analysis.
Setting:
The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.
Patients:
Newborns undergoing hybrid stage 1 palliation from January 2012 to December 2016 who survived to hospital discharge and were followed at our institution.
Interventions:
All patients underwent hybrid stage 1 palliation.
Outcome Measures:
Outcomes included (1) reason for interstage readmission; (2) feeding modality during interstage period; (3) major interstage adverse events; and (4) interstage mortality.
Results:
Study group comprised 57 patients. Five patients only admitted once during the interstage period for scheduled cardiac catheterization were included in the no readmission group. Therefore, 43 patients (75%) had a total of 87 interstage readmissions. Fourteen patients had 15 major interstage adverse events accounting for 17% of total readmissions. Stroke (n = 1); sepsis (n = 1); pericardial effusion requiring drainage (n = 1); mesenteric ischemia (n = 1); shock (n = 1); and cardiac catheterization requiring intervention (n = 11)-ductal stent balloon angioplasty (n = 3), enlargement of atrial septal defect/stent placement (n = 3), retrograde aortic arch stenosis (n = 4). Thirty-three readmissions were secondary to gastrointestinal/feeding issues; 15 cyanosis; 15 work of breathing; and 9 asymptomatic patients. Four patients suffered interstage deaths (7%). Five patients (9%) spent >30 days in the hospital during the interstage period. Of the 47 newborns (82%) discharged exclusively orally feeding, 74% remained all orally feeding throughout interstage period. No patient discharged with tube feedings learned to eat during the interstage period.
Conclusion:
Interstage readmissions are common in the hybrid patient population. Seventeen percent were secondary to major adverse events. Interstage mortality was 7%. Future studies to identify interventions aimed at decreasing feeding issues and viral bronchiolitis in this tenuous patient population will hopefully improve quality outcomes, reduce readmissions, and lessen health care costs.
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