Acuity of Patients Undergoing Congenital Heart Surgery During Hospitalization

Since 2014, Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tools have guided pediatric critical care and acute nurse staffing decisions. Using these data, we constructed a cardiac intensive care postoperative timeline, the CAMEO Acuity Curve, for 3 congenital heart surgery procedures. We now expand both procedures and timeline to comprehensively describe patient acuity during hospitalization.

We reviewed 5 common congenital heart procedures between November 2018 and December 2023-Stage I palliation for single ventricle, arterial switch operation for dextro transposition of great arteries with or without ventricular septal defect repair, tetralogy of Fallot repair, ventricular septal defect repair, and atrial septal defect repair. CAMEO scores from cardiac intensive care unit admission through discharge were abstracted to create procedure-specific CAMEO Acuity Curves. Data were also stratified by severity of residual lesions in anatomic area of repair using the residual lesion score.

Among 574 cases, 72 (13%) were Stage I, 118 (20%) arterial switch operation repair, 144 (25%) tetralogy of Fallot repair, 159 (28%) ventricular septal defect repair, and 81 (14%) atrial septal defect repair. CAMEO scores varied in acuity by procedure. The highest mean acuity was for Stage I (116±6) and the lowest for atrial septal defect repair (94±9). Acuity increased for residual lesion score 3 compared with residual lesion score 1 and 2.

CAMEO Acuity Curves for 5 postoperative congenital heart procedures illustrate expected periods of high acuity. This approach highlights variation by procedure, physiologic status, and hemodynamically significant residual lesions and may inform timely clinical decision-making, guide acuity-specific interprofessional staffing, facilitate throughput, and predict resource needs.