Quality Report: Postoperative Guideline Implementation Reduces Length of Stay after Fontan Procedure

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Quality Improvement Initiatives

Background:

• Patients undergoing the Fontan procedure often experience prolonged pleural effusion, leading to extended hospital stays.
• The average length of stay (LOS) for these patients exceeded the Society of Thoracic Surgeons benchmark.
• A quality improvement project was initiated to address this issue.

Purpose of the Study:

• To decrease the hospital length of stay (LOS) for patients following the Fontan procedure.
• To reduce the average LOS from a baseline of 23 days to 7 days by January 1, 2021.
• To sustain this reduced LOS indefinitely.

Main Methods:

• Standardized postoperative clinical practice guidelines were implemented in April 2020.
• Key interventions included ambulatory PleurX drains, diuresis with fluid restriction, and pulmonary vasodilation therapy.
• Patients were discharged with an indwelling PleurX drain.

Main Results:

• The average hospital LOS for Fontan procedure patients decreased from 23 days pre-implementation to 8 days in 2020 and 7 days post-implementation.
• A total of 107 patients were analyzed pre-guideline and 35 post-guideline.
• There was no significant difference in 30-day readmission rates (24% pre vs. 23% post; P = 0.86).

Conclusions:

• Implementation of standardized clinical practice guidelines effectively reduced hospital LOS in Fontan procedure patients.
• The new guidelines achieved over a 50% reduction in hospital LOS.
• The observed reduction in LOS was achieved without an increase in 30-day readmissions.