Faculty Collaboration Database

Association of 24/7 In-House Intensive Care Unit Attending Physician Coverage With Outcomes in Children Undergoing Heart Operations. Ann Thorac Surg 2016 Dec;102(6):2052-2061

Date

06/22/2016

Pubmed ID

27324525

DOI

10.1016/j.athoracsur.2016.04.042

Scopus ID

2-s2.0-84977583389 (requires institutional sign-in at Scopus site)   11 Citations

Abstract

BACKGROUND: Multicenter data regarding the around-the-clock (24/7) presence of an in-house critical care attending physician with outcomes in children undergoing cardiac operations are limited.

METHODS: Patients younger than 18 years of age who underwent operations (with or without cardiopulmonary bypass [CPB]) for congenital heart disease at 1 of the participating intensive care units (ICUs) in the Virtual PICU Systems (VPS, LLC) database were included (2009-2014). The study population was divided into 2 groups: the 24/7 group (14,737 patients; 32 hospitals), and the No 24/7 group (10,422 patients; 22 hospitals). Propensity-score matching was performed to match patients 1:1 in the 24/7 group and in the No 24/7 group.

RESULTS: Overall, 25,159 patients from 54 hospitals qualified for inclusion. By propensity matching, 9,072 patients (4,536 patient pairs) from 51 hospitals were matched 1:1 in the 2 groups. After matching, mortality at ICU discharge was lower among the patients treated in hospitals with 24/7 coverage (24/7 versus No 24/7, 2.8% versus 4.0%; p = 0.002). The use of extracorporeal membrane oxygenation (ECMO), the incidence of cardiac arrest, extubation within 48 hours after operation, the rate of reintubation, and the duration of arterial line and central venous line use after operation were significantly improved in the 24/7 group. When stratified by surgical complexity, survival benefits of 24/7 coverage persisted among patients undergoing both high-complexity and low-complexity operations.

CONCLUSIONS: The presence of 24-hour in-ICU attending physician coverage in children undergoing cardiac operations is associated with improved outcomes, including ICU mortality. It is possible that 24-hour in-ICU attending physician coverage may be a surrogate for other factors that may bias the results. Further study is warranted.

Author List

Gupta P, Rettiganti M, Jeffries HE, Brundage N, Markovitz BP, Scanlon MC, Simsic JM

Author

Matthew C. Scanlon MD Professor in the Pediatrics department at Medical College of Wisconsin

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

Adolescent
Cardiac Surgical Procedures
Child
Child, Preschool
Critical Care
Databases, Factual
Female
Heart Defects, Congenital
Humans
Infant
Intensive Care Units, Pediatric
Male
Medical Staff, Hospital
Personnel Staffing and Scheduling
Propensity Score
Workload