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Erschienen in: Pediatric Cardiology 3/2016

07.01.2016 | Original Article

Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

verfasst von: Eric A. Johnson, M. Mujeeb Zubair, Laurie R. Armsby, Grant H. Burch, Milon K. Good, Michael R. Lasarev, A. Roger Hohimer, Ashok Muralidaran, Stephen M. Langley

Erschienen in: Pediatric Cardiology | Ausgabe 3/2016

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Abstract

Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p < 0.001), and unplanned postoperative cardiac catheterization (p < 0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1–2.2, p = 0.014), 1.7 (95 % CI 1.2–2.3, p = 0.001), 1.8 (95 % CI 1.4–2.3, p < 0.001), and 2.0 (95 % CI 1.7–2.4, p < 0.001) times as long, respectively. These effects equated to an additional 4.5–7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.
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Literatur
1.
Zurück zum Zitat Agarwal HS, Wolfram KB, Saville BR, Donahue BS, Bichell DP (2014) Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg 148:609–616CrossRefPubMed Agarwal HS, Wolfram KB, Saville BR, Donahue BS, Bichell DP (2014) Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg 148:609–616CrossRefPubMed
2.
Zurück zum Zitat Anderson JB, Czosek RJ, Knilans TK, Meganathan K, Heaton P (2012) Postoperative heart block in children with common forms of congenital heart disease: results from the KID Database. J Cardiovasc Electrophysiol 23:1349–1354CrossRefPubMed Anderson JB, Czosek RJ, Knilans TK, Meganathan K, Heaton P (2012) Postoperative heart block in children with common forms of congenital heart disease: results from the KID Database. J Cardiovasc Electrophysiol 23:1349–1354CrossRefPubMed
3.
Zurück zum Zitat Asoh K, Hickey E, Dorostkar PC, Chaturvedi R, van Arsdell G, Humpl T et al (2009) Outcomes of emergent cardiac catheterization following pediatric cardiac surgery. Catheter Cardiovasc Interv 73:933–940CrossRefPubMed Asoh K, Hickey E, Dorostkar PC, Chaturvedi R, van Arsdell G, Humpl T et al (2009) Outcomes of emergent cardiac catheterization following pediatric cardiac surgery. Catheter Cardiovasc Interv 73:933–940CrossRefPubMed
4.
Zurück zum Zitat Birkmeyer JD, Dimick JB, Birkmeyer NJO (2004) Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198:626–632CrossRefPubMed Birkmeyer JD, Dimick JB, Birkmeyer NJO (2004) Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198:626–632CrossRefPubMed
5.
Zurück zum Zitat Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ (2003) Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med 31:28–33CrossRefPubMed Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ (2003) Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med 31:28–33CrossRefPubMed
6.
Zurück zum Zitat Dunteman GH (1989) Principal components analysis. SAGE, Newbury Park Dunteman GH (1989) Principal components analysis. SAGE, Newbury Park
7.
Zurück zum Zitat Grant SW, Hickey GJ, Cosgriff R (2013) Creating transparency in UK adult cardiac surgery data. Heart 99:1067–1068CrossRefPubMed Grant SW, Hickey GJ, Cosgriff R (2013) Creating transparency in UK adult cardiac surgery data. Heart 99:1067–1068CrossRefPubMed
8.
Zurück zum Zitat Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118CrossRefPubMed Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118CrossRefPubMed
9.
Zurück zum Zitat Larrazabal LA, del Nido PJ, Jenkins KJ, Gauvreau K, Lacro R, Colan S et al (2007) Measurement of technical performance in congenital heart surgery: a pilot study. Ann Thorac Surg 83:179–184CrossRefPubMed Larrazabal LA, del Nido PJ, Jenkins KJ, Gauvreau K, Lacro R, Colan S et al (2007) Measurement of technical performance in congenital heart surgery: a pilot study. Ann Thorac Surg 83:179–184CrossRefPubMed
10.
Zurück zum Zitat Mainz J (2003) Developing evidence-based clinical indicators: a state of the art methods primer. Int J Qual Health Care 15:i5–i11CrossRefPubMed Mainz J (2003) Developing evidence-based clinical indicators: a state of the art methods primer. Int J Qual Health Care 15:i5–i11CrossRefPubMed
11.
Zurück zum Zitat Mainz J (2003) Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care 15:523–530CrossRefPubMed Mainz J (2003) Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care 15:523–530CrossRefPubMed
12.
Zurück zum Zitat Nathan M, Karamichalis J, Liu H, Gauvreau K, Colan S, Saia M et al (2014) Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years. J Thorac Cardiovasc Surg 147:389–396CrossRefPubMed Nathan M, Karamichalis J, Liu H, Gauvreau K, Colan S, Saia M et al (2014) Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years. J Thorac Cardiovasc Surg 147:389–396CrossRefPubMed
13.
Zurück zum Zitat Newburger JW, Wypij D, Bellinger DC, Du Plessis AJ, Kuban KC, Rappaport LA et al (2003) Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J Pediatr 143:67–73CrossRefPubMed Newburger JW, Wypij D, Bellinger DC, Du Plessis AJ, Kuban KC, Rappaport LA et al (2003) Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J Pediatr 143:67–73CrossRefPubMed
14.
Zurück zum Zitat O’Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, Pizarro C et al (2009) An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 138:1139–1153CrossRefPubMed O’Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, Pizarro C et al (2009) An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 138:1139–1153CrossRefPubMed
15.
Zurück zum Zitat Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, Moll JJ (2011) Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg 40:179–184CrossRefPubMed Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, Moll JJ (2011) Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg 40:179–184CrossRefPubMed
16.
Zurück zum Zitat Schwarz GH (1978) Estimating the dimension of a model. Ann Stat 6:461–464CrossRef Schwarz GH (1978) Estimating the dimension of a model. Ann Stat 6:461–464CrossRef
17.
Zurück zum Zitat Searle SR, Speed FM, Milliken GA (1980) Population marginal means in the linear model: an alternative to least squares means. Am Stat 34:216–221 Searle SR, Speed FM, Milliken GA (1980) Population marginal means in the linear model: an alternative to least squares means. Am Stat 34:216–221
18.
Zurück zum Zitat Shahian DM, Edwards FH, Ferraris VA, Haan CK, Rich JB, Normand ST et al (2007) Quality measurement in adult cardiac surgery: part 1—conceptual framework and measure selection. Ann Thorac Surg 83:S3–S12CrossRefPubMed Shahian DM, Edwards FH, Ferraris VA, Haan CK, Rich JB, Normand ST et al (2007) Quality measurement in adult cardiac surgery: part 1—conceptual framework and measure selection. Ann Thorac Surg 83:S3–S12CrossRefPubMed
19.
Zurück zum Zitat Siehr SL, Martin MH, Axelrod D, Efron B, Peng L, Roth SJ et al (2014) Outcomes following cardiac catheterization after congenital heart surgery. Catheter Cardiovasc Interv 84:622–628CrossRefPubMed Siehr SL, Martin MH, Axelrod D, Efron B, Peng L, Roth SJ et al (2014) Outcomes following cardiac catheterization after congenital heart surgery. Catheter Cardiovasc Interv 84:622–628CrossRefPubMed
20.
Zurück zum Zitat Sinzobahamvya N, Weber T, Sata S, Haun C, Arenz C, Photiadis J et al (2013) Quantification of morbidity associated with congenital heart surgery. Thorac Cardiovasc Surg 61:278–285PubMed Sinzobahamvya N, Weber T, Sata S, Haun C, Arenz C, Photiadis J et al (2013) Quantification of morbidity associated with congenital heart surgery. Thorac Cardiovasc Surg 61:278–285PubMed
23.
Zurück zum Zitat Szekely A, Erzsebet E, Kiraly L, Szatmari A, Dinya E (2006) Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Pediatr Anesth 16:1166–1175 Szekely A, Erzsebet E, Kiraly L, Szatmari A, Dinya E (2006) Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Pediatr Anesth 16:1166–1175
24.
Zurück zum Zitat Welke KF, Karamlou T, Ungerleider RM, Diggs BS (2010) Mortality rate is not a valid indicator of quality differences between pediatric cardiac surgical programs. Ann Thorac Surg 89:139–146CrossRefPubMed Welke KF, Karamlou T, Ungerleider RM, Diggs BS (2010) Mortality rate is not a valid indicator of quality differences between pediatric cardiac surgical programs. Ann Thorac Surg 89:139–146CrossRefPubMed
25.
Zurück zum Zitat Welsby IJ, Bennett-Guerrero E, Atwell D, White WD, Newman MF, Smith PK et al (2002) The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg 94:1072–1078CrossRefPubMed Welsby IJ, Bennett-Guerrero E, Atwell D, White WD, Newman MF, Smith PK et al (2002) The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg 94:1072–1078CrossRefPubMed
Metadaten
Titel
Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease
verfasst von
Eric A. Johnson
M. Mujeeb Zubair
Laurie R. Armsby
Grant H. Burch
Milon K. Good
Michael R. Lasarev
A. Roger Hohimer
Ashok Muralidaran
Stephen M. Langley
Publikationsdatum
07.01.2016
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 3/2016
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-015-1319-x

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