Variation in care for infants undergoing the Stage II palliation for hypoplastic left heart syndrome

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease Management
• Clinical Practice Variation Analysis

Background:

• The Single Ventricle Reconstruction trial investigated systemic-to-pulmonary-artery shunt strategies in neonates with hypoplastic left heart syndrome.
• Patient care followed usual institutional practices, prompting an analysis of practice variation.
• The study aimed to identify areas for decreased variation and improved process control in Stage II surgery.

Purpose of the Study:

• To analyze practice variations in Stage II surgery for neonates with hypoplastic left heart syndrome.
• To identify potential areas for standardization and process improvement in perioperative care.
• To inform the development of best practices for managing single ventricle physiology.

Main Methods:

• Utilized prospectively collected data from the Single Ventricle Reconstruction public-use database.
• Described practice variations across 14 participating centers for 397 patients undergoing Stage II surgery.
• Reported center-level data as interquartile ranges for key perioperative factors.

Main Results:

• Significant variation observed in preoperative factors, including patient age (median 5.4 months) and weight (median 5.7 kg).
• Wide differences in the use of medications (e.g., digoxin), feeding practices, and surgical approaches (bidirectional Glenn vs. hemi-Fontan).
• Variations noted in cardiopulmonary bypass times (median 96 minutes), deep hypothermic circulatory arrest duration, and extubation timing.

Conclusions:

• The Single Ventricle Reconstruction Trial revealed substantial practice variation among centers for nearly all perioperative factors surrounding Stage II surgery.
• This wide variation highlights opportunities for establishing standardized best practices.
• Further analysis is crucial to determine the impact of practice variation and optimize patient management.