Emergency department utilisation and critical readmission in patients with Fontan circulation. Cardiol Young 2020 Dec;30(12):1902-1909
Date
10/31/2020Pubmed ID
33121551DOI
10.1017/S1047951120003121Scopus ID
2-s2.0-85095442824 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
BACKGROUND: We aimed to conduct a multi-centre study characterising emergency department utilisation and critical readmissions experienced by children with Fontan circulation.
METHODS: We conducted a retrospective review of children who underwent the Fontan operation at three institutions (i.e., centres A, B, and C) between 2009 and 2014, with follow-up through December 2015. Multi-variable analyses were performed to determine factors associated for emergency department utilisation within 1 year of surgery, emergency department utilisation at any time following surgery, or critical readmission (defined as admission to ICU, operating room, or cardiac catheterisation).
RESULTS: We reviewed 297 patients, of which 147 patients (49%) had 607 emergency department encounters. Forty-six patients (15%) required 71 critical readmissions. Multi-variable analyses revealed centre C (p = 0.02) and post-operative hospitalisation ≥ 14 days (p = 0.03) to be significantly associated with emergency department utilisation within 1 year, whereas centre B (p < 0.001), post-operative hospitalisation ≥ 14 days (p = 0.002), and African-American/Black race (p = 0.04) were significantly associated with critical readmission.
CONCLUSIONS: In this multi-centre study, nearly half of patients with Fontan circulation received emergency department care, often presenting with high disease acuity requiring readmission. Emergency department utilisation and need for critical readmission were independently influenced by the centre at which surgery was performed, prolonged post-operative hospitalisation, and racial background. These data could help guide quality improvement efforts aimed at reducing morbidity in this unique patient population.
Author List
Cashen K, Petersen TL, Rood C, Cater D, Waslawski SF, Slaven JE, Mastropietro CWAuthor
Tara L. Petersen MS, MD Vice-Chair, Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
ChildEmergency Service, Hospital
Fontan Procedure
Hospitalization
Humans
Patient Readmission
Retrospective Studies
Risk Factors
