Invasive Cardiac Procedures in Interstage Single Ventricle Patients in Emergent Hospitalizations.

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Health Services Research

Background:

• Single ventricle congenital heart disease (SV CHD) poses significant risks to patients between palliative surgeries (interstage).
• Acute presentations in interstage SV CHD patients often necessitate invasive cardiac procedures.
• Comparing elective versus emergent interventions is crucial for optimizing patient outcomes and resource allocation.

Purpose of the Study:

• To compare the outcomes and costs of elective versus emergent invasive cardiac procedures in interstage SV CHD patients.
• To identify differences in length of stay, complication rates, in-hospital mortality, and direct costs.
• To inform strategies for improving interstage care and reducing the need for emergent interventions.

Main Methods:

• Retrospective analysis of discharge data from a national healthcare analytics platform (Vizient Clinical Data Base/Resource Manager™).
• Inclusion of pediatric patients (1-6 months old) with SV CHD undergoing invasive cardiac procedures between October 2014 and December 2017.
• Comparison of demographics, length of stay (LOS), complication rates, in-hospital mortality, and direct costs between elective and emergent admissions using appropriate statistical tests (t-test or chi-squared).

Main Results:

• Out of 871 admissions, 141 (16%) were emergent, with younger patients admitted emergently (2.9 vs. 4 months).
• Emergent admissions for cardiac catheterization or superior cavo-pulmonary anastomosis showed significantly longer LOS (58.7 vs. 25.8 days; 54.8 vs. 22.6 days) and higher direct costs ($134,774 vs. $84,253; $158,679 vs. $81,899).
• No significant differences in complication rates or in-hospital mortality were observed between elective and emergent groups for these procedures.

Conclusions:

• Emergent invasive cardiac procedures for interstage SV CHD patients are associated with increased LOS and costs, particularly for cardiac catheterization and superior cavo-pulmonary anastomosis.
• Despite increased resource utilization, emergent interventions did not result in worse complication or mortality rates.
• Findings support enhanced interstage monitoring to proactively manage SV CHD patients and minimize the need for emergent procedures, thereby improving care efficiency and potentially reducing healthcare expenditures.