Unplanned Hospitalization Due to All-Cause Morbidity and Its Real-World Management Practices in Patients With Fontan...

Management strategies of unplanned hospitalizations (UPH) vary and have not been well characterized in patients with Fontan circulation.

We prospectively followed 3226 Fontan patients for 3 years to characterize the current UPH status and elucidate the associations between in-hospital management strategies and postdischarge outcomes.

A total of 243 UPHs occurred (2.5 cases/100 person-years). Fontan-related UPHs accounted for 154 cases (63%), most commonly due to heart failure (19%), protein-losing enteropathy (16%), hemorrhage (14%), arrhythmia (9%), thromboembolism (3%), and plastic bronchitis (2%). Fontan-unrelated UPHs (89 cases; 37%) were mainly due to infections (19%). Adult patients were more frequently hospitalized for hemorrhage and thromboembolism (P<0.05). The longest length of hospital stay was observed in protein-losing enteropathy, followed by thromboembolism and heart failure. Among nonpharmacological treatments, oxygen therapy was commonly used, followed by surgical procedures and catheter-based interventions. Among pharmacological treatments, diuretics were commonly administered, followed by heparin and catecholamines. Of 240 patients discharged alive, 76 (15.4 cases/100 person-years) were readmitted. Protein-losing enteropathy was the most frequent cause of readmission, followed by heart failure and hemorrhage. In addition to conventional risk factors, in-hospital management practices, such as oxygen therapy, surgical intervention, and diuretic adjustment were associated with readmission risk (P<0.01-0.001).

We clarified real-world practices related to UPHs in Fontan patients. Specific in-hospital treatment strategies were associated with the risk of readmission. Further studies are warranted to determine the causal relationships between treatment approaches and outcomes for standardized management strategies.