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Published on: June 8, 2022
Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway
Alex J Katz1, Richard P Lion2, Timothy Martens3
1Department of Pediatrics, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA.
Insights
Implementing a standardized perioperative clinical pathway for pediatric pulmonary valve replacement surgery safely reduced hospital stays and eliminated short-term complications. This approach offers a model for improving care and reducing costs at other institutions.
Area of Science:
- Pediatric Cardiac Surgery
- Clinical Pathway Implementation
- Health Services Research
Background:
- Standardizing perioperative care can optimize resource use and enhance patient outcomes.
- A clinical pathway was implemented for pediatric elective pulmonary valve replacement.
- Outcomes were compared to national benchmarks.
Purpose of the Study:
- To describe outcomes after implementing a perioperative clinical pathway for pediatric pulmonary valve replacement.
- To compare these outcomes with national benchmarks.
Main Methods:
- Retrospective, single-center descriptive study.
- Included pediatric patients undergoing pulmonary valve replacement (2017-2020).
- Assessed hospital length of stay, 30-day reintervention, readmission, and mortality.
Main Results:
- 33 pediatric patients included (median age 11 years).
- Common diagnosis: Tetralogy of Fallot (61%) with pulmonary valve insufficiency (88%).
- Median length of stay: 2 days; no 30-day readmissions, reinterventions, or mortalities.
Conclusions:
- A formalized perioperative clinical pathway for pulmonary valve replacement is safe and effective.
- It leads to shorter hospital stays without short-term adverse events.
- This pathway can be disseminated to reduce length of stay and costs nationally.
Background:
Standardization of perioperative care can reduce resource utilization while improving patient outcomes. We sought to describe our outcomes after the implementation of a perioperative clinical pathway for pediatric patients undergoing elective surgical pulmonary valve replacement and compare these results to previously published national benchmarks.
Methods:
A retrospective single-center descriptive study was conducted of all pediatric patients who underwent surgical pulmonary valve replacement from 2017 through 2020, after the implementation of a clinical pathway. Outcomes included hospital length of stay and 30-day reintervention, readmission, and mortality.
Results:
Thirty-three patients (55% female, median age 11 [7, 13] years, 32 [23, 44] kg) were included in the study. Most common diagnosis and indication for surgery was Tetralogy of Fallot (61%) with pulmonary valve insufficiency (88%). All patients had prior cardiac surgery. Median hospital length of stay was 2 [2, 2] days, and longest length of stay was three days. There were no 30-day readmissions, reinterventions, or mortalities. Median follow-up time was 19 [9, 31] months.
Conclusions:
Formalization of a perioperative surgical pulmonary valve replacement clinical pathway can safely promote short hospital length of stay without any short-term readmissions or reinterventions, especially when compared with previously published benchmarks. Such formalization enables the dissemination of best practices to other institutions to reduce hospital length of stay and limit costs.
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