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Minimising an outpatient medication regimen after paediatric cardiac surgery
Jamie Smith Penk1, Lindsay Jackson2, Guilherme Baptista de Faria2
1Dell Children's Medical Center of Central Texas, USA.
Insights
This study optimized outpatient medication after pediatric cardiac surgery, limiting furosemide and using targeted ibuprofen. This approach reduced pericardial effusion readmissions without increasing pleural effusion readmissions.
Area of Science:
- Cardiology
- Pediatric Surgery
- Pharmacology
Background:
- Optimizing outpatient medication regimens post-pediatric cardiac surgery is crucial for patient recovery.
- Previous strategies limiting furosemide reduced pleural effusion readmissions but increased pericardial effusions.
- Prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) decreased pericardial effusion readmissions in prior quality improvement projects.
Purpose of the Study:
- To design and evaluate an outpatient medication regimen minimizing furosemide and utilizing targeted ibuprofen after pediatric cardiac surgery.
- To assess the impact of this new regimen on readmission rates for pleural and pericardial effusions.
Main Methods:
- A single-center analysis of outcomes following the implementation of a quality improvement initiative.
- The initiative aimed to limit outpatient diuretic use (≤5 days) and incorporate targeted ibuprofen for high-risk patients.
- Patient data was analyzed to determine adherence to the limited diuretic regimen and appropriate ibuprofen use.
Main Results:
- 160 patients received a limited diuretic regimen; 53 (33.1%) were prescribed targeted ibuprofen based on high-risk criteria.
- Readmission rates were low: one for pleural effusion and 2/160 (1.3%) for pericardial effusion.
- The pericardial effusion readmission rate (1.3%) was significantly lower than the 6.6% observed in a previous trial using furosemide alone (p = 0.04).
Conclusions:
- A medication regimen with limited outpatient furosemide can be implemented without increasing pleural effusion readmissions.
- Targeted ibuprofen use in high-risk patients effectively reduced pericardial effusion readmissions post-pediatric cardiac surgery.
- This optimized regimen offers an improved approach to managing post-operative care for pediatric cardiac surgery patients.
Background:
We implemented a quality improvement initiative to optimise the outpatient medication regimen after paediatric cardiac surgery. A previous trial that limited furosemide found no readmissions for pleural effusion but an increase in pericardial effusions. A similar quality improvement project had implemented prophylactic non-steroidal anti-inflammatory drugs and found a decrease in readmissions for pericardial effusion. We used these results to design an outpatient medication regimen that minimises furosemide and uses only targeted ibuprofen and report readmission rates from this project.
Methods:
Single-centre analysis of outcomes since the adoption of a quality improvement initiative aiming to limit outpatient diuretics (≤5 days) while using targeted ibuprofen to prevent pericardial effusion readmissions.
Results:
Two hundred and one patients were eligible for analysis. Forty-one patients (20.4%) were prescribed >20 days of diuretics due to compliance failure and were not considered to have received a limited diuretic regimen, leaving 160 patients. Of those, 53 (33.1%) were correctly prescribed targeted ibuprofen based on meeting "high-risk" criteria. There was one readmission for pleural effusion and 2/160 (1.3%) readmissions for pericardial effusion. The previous prospective study of limited furosemide without ibuprofen had a pericardial effusion readmission rate of 4/61 (6.6%) versus the 2/160 (1.3%) after implementing the regimen described in this report (p = 0.04).
Conclusions:
We describe a medication regimen using limited outpatient furosemide without increased readmissions for pleural effusions. Targeted ibuprofen was used for high-risk patients only, and there were fewer readmissions for pericardial effusions than in a previous trial that used furosemide alone.
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