Determinants of Length of Stay after Neonatal Cardiac Surgery Using Path Analysis

Area of Science:

• Pediatric Cardiology
• Neonatal Surgery
• Clinical Outcomes Research

Background:

• Families and healthcare teams aim for exclusive oral feedings before discharge for neonates undergoing cardiac surgery.
• The impact of exclusive oral feedings on length of stay (LOS) after neonatal cardiac surgery requires further investigation.

Purpose of the Study:

• To test the hypothesis that exclusive oral feedings reduce length of stay (LOS) in neonates following cardiac surgery.
• To identify key determinants influencing LOS in this patient population.

Main Methods:

• A cross-sectional study of 280 neonates from 2009-2013.
• Multidimensional path analysis modeled Buttigieg, Abela, and Pace's framework for LOS determinants.
• Controlled for covariances including sepsis, birth distance, necrotizing enterocolitis, genetic differences, and specialty consults.

Main Results:

• The recursive path model demonstrated good global and local fit, explaining 26% of outcome variances for exclusive oral feeding and LOS.
• Age at neonatal cardiac surgery (β = .23, p ≤ .001) and duration of postoperative intubation (β = .47, p ≤ .001) were significant predictors of LOS.
• Exclusive oral feedings at discharge did not significantly mediate the influence on LOS.

Conclusions:

• Exclusive oral feedings are not a primary driver for reducing length of stay in neonates after cardiac surgery.
• Postoperative intubation duration and the timing of surgery are more critical factors affecting length of stay.