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Published on: July 18, 2014
Time to Transfer and Hospitalization Duration for Severe Congenital Heart Defects: Implications for Perinatal
Joyce Woo1, William A Grobman2, Michael C Mongé3
1Division of Pediatric Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
Late transfer of neonates with severe congenital heart defects (CHDs) from non-surgical centers is linked to longer hospital stays. Optimizing transfer timing is crucial for improving outcomes in these vulnerable infants.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Public Health
Background:
- Severe congenital heart defects (CHDs) are a significant cause of neonatal morbidity.
- Many neonates requiring complex cardiac surgery are not born at specialized surgical centers.
- Timely transfer to a cardiac surgical center is critical for optimal neonatal care.
Purpose of the Study:
- To investigate the association between the timing of transfer to a surgical center and the duration of hospitalization for neonates with severe CHDs.
- To identify if delayed transfer impacts neonatal length of stay.
Main Methods:
- Retrospective analysis of 1,391 neonates with severe CHD from 2013-2021.
- Categorized time-to-transfer: birth at surgical center, transfer at 0, 1-3, or >3 days.
- Used Fine-Gray models to estimate discharge rates, accounting for competing risks, and restricted mean survival time for hospitalization duration.
Main Results:
- 48.1% of neonates with severe CHD were not born at a cardiac surgical center.
- Transfer after 3 days was associated with a slower rate of discharge (adjusted sHR 0.71).
- Late transfer (>3 days) was significantly linked to longer hospitalization duration.
Conclusions:
- Delayed transfer of neonates with severe CHD from non-surgical centers is associated with prolonged hospitalization.
- Early transfer to specialized centers may reduce length of stay and improve resource utilization.
- This highlights the importance of efficient transfer protocols for neonates with complex cardiac conditions.
Objective:
To estimate the associations between time to transfer and hospitalization duration among neonates with severe congenital heart defects (CHDs).
Study Design:
Retrospective, cross-sectional analysis of neonates with severe CHD, 2013-2021, who were reported to the Illinois Department of Public Health. The outcome was hospitalization duration-time from birth to discharge from a surgical center. The exposure was time to transfer (4 categories): birth at a surgical center (referent), not born at a surgical center and transferred at 0, 1-3, or after 3 days. Covariates included clinical and sociodemographic factors. Fine-Gray models estimated subdistribution hazard ratios for discharge, accounting for competing risks. Restricted mean survival time summarized the average hospitalization duration at different timepoint cutoffs.
Results:
Among 1391 neonates with severe CHD, 48.1% (669/1391) were not born at a cardiac surgical center. Of those who were transferred, 43.4% (203/468) were transferred at 0 days, 43.8% (205/468) were transferred within 1-3 days, and 12.8% (60/468) were transferred after 3 days. The median hospitalization duration was 23 days (IQR, 12-46 days). Compared with birth at a cardiac surgical center, transfer after 3 days was associated with a slower rate of discharge over time (adjusted subdistribution hazard ratio, 0.71; 95% CI, 0.54-0.94) and longer hospitalization duration.
Conclusions:
For the substantial proportion of neonates with severe CHD who were not born at cardiac surgical centers, late transfer was associated with a longer neonatal hospitalization duration.
