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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Patients With Congenital Heart Disease Undergoing Noncardiac Procedures at Hospitals With and Without a Cardiac
Viviane G Nasr1, Urbano L França1, Meena Nathan2
1Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston MA.
Insights
Patients with congenital heart disease (CHD) are more likely to have noncardiac procedures at hospitals with cardiac programs, especially those with complex conditions. This trend is observed despite potentially longer travel distances for specialized care.
Area of Science:
- Pediatric Cardiology
- Healthcare Systems Research
- Public Health
Background:
- The location and characteristics of hospitals providing noncardiac procedures for pediatric patients with congenital heart disease (CHD) remain understudied.
- Understanding these patterns is crucial for optimizing care delivery and patient outcomes.
Purpose of the Study:
- To characterize patients with CHD undergoing noncardiac procedures.
- To analyze the distribution of these procedures across hospitals with and without cardiac surgical programs.
- To identify factors influencing this distribution and assess associated mortality rates.
Main Methods:
- Retrospective analysis of inpatient data from three state databases (Massachusetts, Texas, and HCUP).
- Inclusion criteria: patients under 18 with CHD undergoing noncardiac procedures.
- Statistical analysis included distance calculations (Haversine formula) and logistic regression to determine factors associated with procedure location.
Main Results:
- 7,435 procedures across 235 hospitals were analyzed.
- The majority (87.8%) occurred at hospitals with cardiac programs.
- Patients treated at hospitals without cardiac programs predominantly had simple CHD, while those at hospitals with programs had a higher proportion of complex and single-ventricle disease.
- Factors like single ventricle disease and multiple chronic conditions increased the likelihood of receiving care at a hospital with a cardiac program.
Conclusions:
- Patients with CHD, particularly those with complex conditions like single ventricle disease, are preferentially treated at hospitals with cardiac surgical programs for noncardiac procedures.
- This suggests a centralization of care for higher-risk pediatric CHD patients.
- The overall mortality rate for these procedures was 3.8%.
Abstract:
Background The type and location of hospitals where patients with congenital heart disease (CHD) undergo noncardiac procedures have not been investigated. This study aimed to describe (1) the characteristics of these patients, (2) the distribution of procedures among hospitals with and without a cardiac surgical program and travel distances, (3) the characteristics determining the distribution, and (4) mortality rates. Methods and Results This is a retrospective cohort analysis of inpatient data from the Center for Healthcare Information and Analysis of the Commonwealth of Massachusetts, Texas Healthcare Information Collection, and Health Care Cost and Utilization Project State Inpatient Database. Children <18 years old with CHD who underwent noncardiac procedures were included. Distances were calculated using the Haversine formula. Logistic regression was performed to evaluate the odds of a procedure at a hospital with a cardiac program. There were 7435 encounters at 235 hospitals analyzed. Most procedures (87.8%) occurred at hospitals with a cardiac program. Patients at a hospital without a cardiac program had simple CHD (72.4%) with <1% with single ventricle disease. At hospitals with a cardiac program, 56.8% had simple CHD, 35.4% complex CHD, and 7.8% single ventricle disease. The median distance traveled was 25.2 miles (interquartile range, 10.3-73.8 miles) to a hospital with a cardiac program and 14.6 miles (interquartile range, 6.2-37.4 miles) to a hospital without a cardiac program (P<0.001). Single ventricle disease (adjusted odds ratio [aOR], 16.25 [95% CI, 7.22-36.61]) and ≥6 chronic conditions (aOR, 1.81 [95% CI, 1.57-2.09]) were associated with performance at a hospital with a cardiac program. Mortality rate was 3.8%. Conclusions Patients with CHD are more likely to travel to a hospital with a cardiac program for noncardiac procedures than to a hospital without; especially patients with single ventricle disease, other complex CHD, and with ≥6 chronic conditions.
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