Skip to main content
Erschienen in: Pediatric Cardiology 8/2016

24.08.2016 | Original Article

Center Variability in Timing of Stage 2 Palliation and Association with Interstage Mortality: A Report from the National Pediatric Cardiology Quality Improvement Collaborative

verfasst von: Garick D. Hill, Nancy A. Rudd, Nancy S. Ghanayem, David A. Hehir, Peter J. Bartz

Erschienen in: Pediatric Cardiology | Ausgabe 8/2016

Einloggen, um Zugang zu erhalten

Abstract

For infants with single-ventricle lesions with aortic arch hypoplasia, the interstage period from discharge following stage 1 palliation (S1P) until stage 2 palliation (S2P) remains high risk. Significant variability among institutions exists around the timing of S2P. We sought to describe institutional variation in timing of S2P, determine the association between timing of S2P and interstage mortality, and determine the impact of earlier S2P on hospital morbidity and mortality. The National Pediatric Cardiology Quality Improvement Collaborative registry was queried. Centers were divided based on median age at S2P into early (n = 15) and late (n = 16) centers using a cutoff of 153 days. Groups were compared using Chi-squared or Wilcoxon rank-sum test. Multivariable logistic regression was used to determine risk factors for interstage mortality. The final cohort included 789 patients from 31 centers. There was intra- and inter-center variability in timing of S2P, with the median age by center ranging from 109 to 214 days. Late centers had a higher mortality (9.9 vs. 5.7 %, p = 0.03) than early centers. However, the event rate (late: 8.2 vs. early: 5.8 deaths per 10,000 interstage days) was not different by group (p = 0.26). Survival to hospital discharge and hospital length of stay following S2P were similar between groups. In conclusion, in a large multi-institution collaborative, the median age at S2P varies among centers. Although optimal timing of S2P remains unclear, centers performing early S2P did not experience worse S2P outcomes and experienced less interstage mortality.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Anderson JB, Beekman RH, Kugler JD, Rosenthal GL, Jenkins KJ, Klitzner TS, Martin GR, Neish SR, Brown DW, Mangeot C, King E, Peterson LE, Provost L, Lannon C (2015) Improvement in interstage survival in a national pediatric cardiology learning network. Circ Cardiovasc Qual Outcomes 8:428–436CrossRefPubMed Anderson JB, Beekman RH, Kugler JD, Rosenthal GL, Jenkins KJ, Klitzner TS, Martin GR, Neish SR, Brown DW, Mangeot C, King E, Peterson LE, Provost L, Lannon C (2015) Improvement in interstage survival in a national pediatric cardiology learning network. Circ Cardiovasc Qual Outcomes 8:428–436CrossRefPubMed
2.
Zurück zum Zitat Anderson JB, Iyer SB, Schidlow DN, Williams R, Varadarajan K, Horsley M, Slicker J, Pratt J, King E, Lannon C, National Pediatric Cardiology Quality Improvement Collaborative (2012) Variation in growth of infants with a single ventricle. J Pediatr 161:16–21CrossRefPubMed Anderson JB, Iyer SB, Schidlow DN, Williams R, Varadarajan K, Horsley M, Slicker J, Pratt J, King E, Lannon C, National Pediatric Cardiology Quality Improvement Collaborative (2012) Variation in growth of infants with a single ventricle. J Pediatr 161:16–21CrossRefPubMed
3.
Zurück zum Zitat Anderson JB, Beekman RH, Border WL, Kalkwarf HJ, Khoury PR, Uzark K, Eghtesady P, Marino BS (2009) Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 138:397–404CrossRefPubMed Anderson JB, Beekman RH, Border WL, Kalkwarf HJ, Khoury PR, Uzark K, Eghtesady P, Marino BS (2009) Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 138:397–404CrossRefPubMed
4.
Zurück zum Zitat Cnota JF, Allen KR, Colan S, Covitz W, Graham EM, Hehir DA, Levine JC, Margossian R, McCrindle BW, Minich LL, Natarajan S, Richmond ME, Hsu DT, Investigators Pediatric Heart Network (2013) Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle. J Thorac Cardiovasc Surg 145:1288–1296CrossRefPubMed Cnota JF, Allen KR, Colan S, Covitz W, Graham EM, Hehir DA, Levine JC, Margossian R, McCrindle BW, Minich LL, Natarajan S, Richmond ME, Hsu DT, Investigators Pediatric Heart Network (2013) Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle. J Thorac Cardiovasc Surg 145:1288–1296CrossRefPubMed
5.
Zurück zum Zitat Cross RR, Harahsheh AS, McCarter R, Martin GR, National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) (2014) Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the national pediatric cardiology-quality improvement collaborative. Cardiol Young 24:253–262CrossRefPubMed Cross RR, Harahsheh AS, McCarter R, Martin GR, National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) (2014) Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the national pediatric cardiology-quality improvement collaborative. Cardiol Young 24:253–262CrossRefPubMed
6.
Zurück zum Zitat Gaynor JW, Mahle WT, Cohen MI, Ittenbach RF, DeCampli WM, Steven JM, Nicolson SC, Spray TL (2002) Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg 22:82–89CrossRefPubMed Gaynor JW, Mahle WT, Cohen MI, Ittenbach RF, DeCampli WM, Steven JM, Nicolson SC, Spray TL (2002) Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg 22:82–89CrossRefPubMed
7.
Zurück zum Zitat Ghanayem NS, Allen KR, Tabbutt S, Atz AM, Clabby ML, Cooper DS, Eghtesady P, Frommelt PC, Gruber PJ, Hill KD, Kaltman JR, Laussen PC, Lewis AB, Lurito KJ, Minich LL, Ohye RG, Schonbeck JV, Schwartz SM, Singh RK, Goldberg CS, Investigators Pediatric Heart Network (2012) Interstage mortality after the Norwood procedure: Results of the multicenter Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 144:894–906CrossRef Ghanayem NS, Allen KR, Tabbutt S, Atz AM, Clabby ML, Cooper DS, Eghtesady P, Frommelt PC, Gruber PJ, Hill KD, Kaltman JR, Laussen PC, Lewis AB, Lurito KJ, Minich LL, Ohye RG, Schonbeck JV, Schwartz SM, Singh RK, Goldberg CS, Investigators Pediatric Heart Network (2012) Interstage mortality after the Norwood procedure: Results of the multicenter Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 144:894–906CrossRef
8.
Zurück zum Zitat Ghanayem NS, Tweddell JS, Hoffman GM, Mussatto K, Jaquiss RD (2006) Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 16(Suppl 1):61–66CrossRefPubMed Ghanayem NS, Tweddell JS, Hoffman GM, Mussatto K, Jaquiss RD (2006) Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 16(Suppl 1):61–66CrossRefPubMed
9.
Zurück zum Zitat Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA, Steltzer MM, Bevandic SM, Frisbee SS, Jaquiss RD, Litwin SB, Tweddell JS (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377CrossRefPubMed Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA, Steltzer MM, Bevandic SM, Frisbee SS, Jaquiss RD, Litwin SB, Tweddell JS (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377CrossRefPubMed
10.
Zurück zum Zitat Hill GD, Hehir DA, Bartz PJ, Rudd NA, Frommelt MA, Slicker J, Tanem J, Frontier K, Xiang Q, Wang T, Tweddell JS, Ghanayem NS (2014) Effect of feeding modality on interstage growth after stage I palliation: a report from the National Pediatric Cardiology Quality Improvement Collaborative. J Thorac Cardiovasc Surg 148:1534–1539CrossRefPubMedPubMedCentral Hill GD, Hehir DA, Bartz PJ, Rudd NA, Frommelt MA, Slicker J, Tanem J, Frontier K, Xiang Q, Wang T, Tweddell JS, Ghanayem NS (2014) Effect of feeding modality on interstage growth after stage I palliation: a report from the National Pediatric Cardiology Quality Improvement Collaborative. J Thorac Cardiovasc Surg 148:1534–1539CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Jacobs JP, O’Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, Austin EH, Pizarro C, Pourmoghadam KK, Scholl FG, Welke KF, Mavroudis C (2011) Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 92:2184–2192CrossRefPubMedPubMedCentral Jacobs JP, O’Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, Austin EH, Pizarro C, Pourmoghadam KK, Scholl FG, Welke KF, Mavroudis C (2011) Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 92:2184–2192CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Jaquiss RD, Ghanayem NS, Hoffman GM, Fedderly RT, Cava JR, Mussatto KA, Tweddell JS (2004) Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 127:982–989CrossRefPubMed Jaquiss RD, Ghanayem NS, Hoffman GM, Fedderly RT, Cava JR, Mussatto KA, Tweddell JS (2004) Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 127:982–989CrossRefPubMed
13.
Zurück zum Zitat Kogon BE, Plattner C, Leong T, Simsic J, Kirshbom PM, Kanter KR (2008) The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg 136:1237–1242CrossRefPubMed Kogon BE, Plattner C, Leong T, Simsic J, Kirshbom PM, Kanter KR (2008) The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg 136:1237–1242CrossRefPubMed
14.
Zurück zum Zitat Kugler JD, Beekman Iii RH, Rosenthal GL, Jenkins KJ, Klitzner TS, Martin GR, Neish SR, Lannon C (2009) Development of a pediatric cardiology quality improvement collaborative: from inception to implementation. From the Joint Council on Congenital Heart Disease Quality Improvement Task Force. Congenit Heart Dis 4:318–328CrossRefPubMed Kugler JD, Beekman Iii RH, Rosenthal GL, Jenkins KJ, Klitzner TS, Martin GR, Neish SR, Lannon C (2009) Development of a pediatric cardiology quality improvement collaborative: from inception to implementation. From the Joint Council on Congenital Heart Disease Quality Improvement Task Force. Congenit Heart Dis 4:318–328CrossRefPubMed
15.
Zurück zum Zitat Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ (2001) Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics 107:1277–1282CrossRefPubMed Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ (2001) Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics 107:1277–1282CrossRefPubMed
16.
Zurück zum Zitat Menon SC, McCandless RT, Mack GK, Lambert LM, McFadden M, Williams RV, Minich LL (2013) Clinical outcomes and resource use for infants with hypoplastic left heart syndrome during bidirectional Glenn: summary from the Joint Council for Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative registry. Pediatr Cardiol 34:143–148CrossRefPubMed Menon SC, McCandless RT, Mack GK, Lambert LM, McFadden M, Williams RV, Minich LL (2013) Clinical outcomes and resource use for infants with hypoplastic left heart syndrome during bidirectional Glenn: summary from the Joint Council for Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative registry. Pediatr Cardiol 34:143–148CrossRefPubMed
17.
Zurück zum Zitat Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M, Goldberg CS, Tabbutt S, Frommelt PC, Ghanayem NS, Laussen PC, Rhodes JF, Lewis AB, Mital S, Ravishankar C, Williams IA, Dunbar-Masterson C, Atz AM, Colan S, Minich LL, Pizarro C, Kanter KR, Jaggers J, Jacobs JP, Krawczeski CD, Pike N, McCrindle BW, Virzi L, Gaynor JW, Investigators Pediatric Heart Network (2010) Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992CrossRefPubMedPubMedCentral Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M, Goldberg CS, Tabbutt S, Frommelt PC, Ghanayem NS, Laussen PC, Rhodes JF, Lewis AB, Mital S, Ravishankar C, Williams IA, Dunbar-Masterson C, Atz AM, Colan S, Minich LL, Pizarro C, Kanter KR, Jaggers J, Jacobs JP, Krawczeski CD, Pike N, McCrindle BW, Virzi L, Gaynor JW, Investigators Pediatric Heart Network (2010) Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Pasquali SK, Ohye RG, Lu M, Kaltman J, Caldarone CA, Pizarro C, Dunbar-Masterson C, Gaynor JW, Jacobs JP, Kaza AK, Newburger J, Rhodes JF, Scheurer M, Silver E, Sleeper LA, Tabbutt S, Tweddell J, Uzark K, Wells W, Mahle WT, Pearson GD, Investigators Pediatric Heart Network (2012) Variation in perioperative care across centers for infants undergoing the Norwood procedure. J Thorac Cardiovasc Surg 144:915–921CrossRefPubMedPubMedCentral Pasquali SK, Ohye RG, Lu M, Kaltman J, Caldarone CA, Pizarro C, Dunbar-Masterson C, Gaynor JW, Jacobs JP, Kaza AK, Newburger J, Rhodes JF, Scheurer M, Silver E, Sleeper LA, Tabbutt S, Tweddell J, Uzark K, Wells W, Mahle WT, Pearson GD, Investigators Pediatric Heart Network (2012) Variation in perioperative care across centers for infants undergoing the Norwood procedure. J Thorac Cardiovasc Surg 144:915–921CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Petrucci O, Khoury PR, Manning PB, Eghtesady P (2010) Outcomes of the bidirectional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg 139:562–568CrossRefPubMed Petrucci O, Khoury PR, Manning PB, Eghtesady P (2010) Outcomes of the bidirectional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg 139:562–568CrossRefPubMed
20.
Zurück zum Zitat Reddy VM, Liddicoat JR, Hanley FL (1995) Primary bidirectional superior cavopulmonary shunt in infants between 1 and 4 months of age. Ann Thorac Surg 59:1120–1126CrossRefPubMed Reddy VM, Liddicoat JR, Hanley FL (1995) Primary bidirectional superior cavopulmonary shunt in infants between 1 and 4 months of age. Ann Thorac Surg 59:1120–1126CrossRefPubMed
21.
Zurück zum Zitat Scheurer MA, Hill EG, Vasuki N, Maurer S, Graham EM, Bandisode V, Shirali GS, Atz AM, Bradley SM (2007) Survival after bidirectional cavopulmonary anastomosis: analysis of preoperative risk factors. J Thorac Cardiovasc Surg 134:82–89CrossRefPubMed Scheurer MA, Hill EG, Vasuki N, Maurer S, Graham EM, Bandisode V, Shirali GS, Atz AM, Bradley SM (2007) Survival after bidirectional cavopulmonary anastomosis: analysis of preoperative risk factors. J Thorac Cardiovasc Surg 134:82–89CrossRefPubMed
22.
Zurück zum Zitat Slavik Z, Lamb RK, Webber SA, Devlin AM, Keeton BR, Monro JL, Salmon AP (1996) Bidirectional superior cavopulmonary anastomosis: how young is too young? Heart 75:78–82CrossRefPubMedPubMedCentral Slavik Z, Lamb RK, Webber SA, Devlin AM, Keeton BR, Monro JL, Salmon AP (1996) Bidirectional superior cavopulmonary anastomosis: how young is too young? Heart 75:78–82CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Stasik CN, Gelehrter S, Goldberg CS, Bove EL, Devaney EJ, Ohye RG (2006) Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg 131:412–417CrossRefPubMed Stasik CN, Gelehrter S, Goldberg CS, Bove EL, Devaney EJ, Ohye RG (2006) Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg 131:412–417CrossRefPubMed
24.
Zurück zum Zitat Tabbutt S, Ghanayem N, Ravishankar C, Sleeper LA, Cooper DS, Frank DU, Lu M, Pizarro C, Frommelt P, Goldberg CS, Graham EM, Krawczeski CD, Lai WW, Lewis A, Kirsh JA, Mahony L, Ohye RG, Simsic J, Lodge AJ, Spurrier E, Stylianou M, Laussen P, Investigators Pediatric Heart Network (2012) Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 144:882–895CrossRefPubMedPubMedCentral Tabbutt S, Ghanayem N, Ravishankar C, Sleeper LA, Cooper DS, Frank DU, Lu M, Pizarro C, Frommelt P, Goldberg CS, Graham EM, Krawczeski CD, Lai WW, Lewis A, Kirsh JA, Mahony L, Ohye RG, Simsic J, Lodge AJ, Spurrier E, Stylianou M, Laussen P, Investigators Pediatric Heart Network (2012) Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 144:882–895CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD, Ghanayem NS, Frisbee SJ, Litwin SB (2002) Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 106:I82–I89PubMed Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD, Ghanayem NS, Frisbee SJ, Litwin SB (2002) Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 106:I82–I89PubMed
Metadaten
Titel
Center Variability in Timing of Stage 2 Palliation and Association with Interstage Mortality: A Report from the National Pediatric Cardiology Quality Improvement Collaborative
verfasst von
Garick D. Hill
Nancy A. Rudd
Nancy S. Ghanayem
David A. Hehir
Peter J. Bartz
Publikationsdatum
24.08.2016
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 8/2016
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-016-1465-9

Weitere Artikel der Ausgabe 8/2016

Pediatric Cardiology 8/2016 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.