Improving interstage survival after Norwood operation: outcomes from 10 years of home monitoring. J Thorac Cardiovasc Surg 2014 Oct;148(4):1540-7
Date
03/29/2014Pubmed ID
24667026DOI
10.1016/j.jtcvs.2014.02.038Scopus ID
2-s2.0-84908248844 (requires institutional sign-in at Scopus site) 81 CitationsAbstract
OBJECTIVE: Infants who undergo Norwood stage 1 palliation (S1P) continue with high-risk circulation until stage 2 palliation (S2P). Routine care during the interstage period is associated with 10% to 20% mortality. This report illustrates the sustained reduction of interstage mortality over 10 years associated with use of home monitoring.
METHODS: Daily monitoring of oxygen saturation and weight was done for all patients discharged to home after S1P. Notification of the care team occurred for oxygen saturation<75% or >90%, weight gain<20 g over 3 days, weight loss>30 g, or intake<100 cc/kg/d. Breach of these criteria marked an interstage event. Interstage outcomes are reported. Patient characteristics and perioperative variables were compared between patients with and without interstage events.
RESULTS: Over 10 years, 157 patients were discharged after S1P with home monitoring. Interstage survival was 98%. Breach of home criteria occurred in 59% (93 out of 157), with violation of oxygen saturation<75% the most common event. Patient characteristics, operative data, and early postoperative morbidity did not differ between patients with and without events.
CONCLUSIONS: Home monitoring after S1P is associated with excellent interstage survival. Although a breach of monitoring criteria occurred in more than half of patients, our analysis failed to identify independent predictors of interstage events. Analysis of variables predicting mortality could not be assessed due to the low frequency of death in this cohort. Failure to identify specific variables for interstage events suggests that home monitoring, as part of an interstage surveillance program, should be applied to all S1P hospital survivors.
Author List
Rudd NA, Frommelt MA, Tweddell JS, Hehir DA, Mussatto KA, Frontier KD, Slicker JA, Bartz PJ, Ghanayem NSAuthors
Peter J. Bartz MD Chief, Professor in the Pediatrics department at Medical College of WisconsinMichele Ann Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering
Nancy A. Rudd RN APP Inpatient 1 in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Energy IntakeFemale
Home Care Services, Hospital-Based
Humans
Hypoplastic Left Heart Syndrome
Infant
Infant, Newborn
Male
Monitoring, Ambulatory
Norwood Procedures
Oximetry
Oxygen
Palliative Care
Quality Improvement
Risk Factors
Survival Rate
Treatment Outcome
Weight Gain
