Faculty Collaboration Database

Impact of Reintervention During Stage 1 Palliation Hospitalization: A National, Multicenter Study. Ann Thorac Surg 2023 Apr;115(4):975-981

Date

10/29/2022

Pubmed ID

36306859

DOI

10.1016/j.athoracsur.2022.10.014

Scopus ID

2-s2.0-85142376895 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Stage 1 palliation (S1P) for hypoplastic left heart syndrome remains associated with high morbidity and mortality. Previous studies on burden of reinterventions did not include patients who remain hospitalized before stage 2 palliation (S2P). This study described the rate of reintervention during S1P hospitalization and sought to determine the impact of reintervention on outcomes.

METHODS: All participants enrolled in phase II of the National Pediatric Cardiology Quality Improvement Collaborative after S1P were included in this study. The primary outcome was the rate of reintervention during hospitalization after S1P and before hospital discharge or S2P. Reintervention was defined as 1 or more unplanned interventional cardiac catheterizations or surgical reoperations.

RESULTS: Between March 1, 2016 and October 1, 2019, 1367 participants underwent S1P and 339 (24.8%) had a reintervention; most commonly to address the source of pulmonary blood flow. Gestational age, weight at S1P, atrioventricular septal defect, heterotaxy, preoperative pulmonary artery bands, hybrid S1P, and an additional bypass run or early extracorporeal membrane oxygenation were significantly associated with reintervention. Participants in the reintervention group experienced higher rates of nearly all postoperative complications, were less likely to be discharged before S2P (57.1% vs 86%; P < .001), and more likely to experience in-hospital mortality (17% vs 5%; P < .001).

CONCLUSIONS: Unplanned reintervention during hospitalization after S1P palliation occurred in 25% of participants in a large, registry-based national cohort. Participants who underwent reintervention were more likely to remain as inpatient and were less likely to survive to S2P. Reintervention was associated with a multitude of postoperative complications that affect survival and long-term outcome.

Author List

Handler SS, Chan T, Ghanayem NS, Rudd N, Wright G, Visotcky A, Sparapani R, Mitchell ME, Hoffman GM, Frommelt MA

Authors

Michele Ann Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Stephanie S. Handler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Alexis M. Visotcky Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child
Hospitalization
Humans
Hypoplastic Left Heart Syndrome
Norwood Procedures
Palliative Care
Postoperative Complications
Retrospective Studies
Risk Factors
Treatment Outcome