Predictors of prolonged length of intensive care unit stay after stage i palliation

A report from the National Pediatric Cardiology Quality Improvement Collaborative

Carissa M. Baker-Smith, Carolyn M. Wilhelm, Steven R. Neish, Thomas S. Klitzner, Robert H. Beekman, John Dale Kugler, Gerard R. Martin, Carole Lannon, Kathy J. Jenkins, Geoffrey L. Rosenthal

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

The objective of this study is to identify predictors of prolonged intensive care unit (ICU) length of stay (LOS) for single ventricle patients following Stage I palliation. We hypothesize that peri-operative factors contribute to prolonged ICU stay among children with hypoplastic left heart syndrome (HLHS) and its variants. In 2008, as a part of the Joint Council on Congenital Heart Disease initiative, the National Pediatric Cardiology-Quality Improvement Collaborative established a data registry for patients with HLHS and its variants undergoing staged palliation. Between July 2008 and August 2011, 33 sites across the United States submitted discharge data essential to this analysis. Data describing the patients, their procedures, and their hospital experience were entered. LOS estimates were generated. Prolonged LOS in the ICU was defined as stay greater than or equal to 26 days (i.e., 75th percentile). Statistical analyses were carried out to identify pre-operative, operative, and post-operative predictors of prolonged LOS in the ICU. The number of patients with complete discharge data was 303, and these subjects were included in the analysis. Univariate and multivariate analyses were performed. Multivariate analysis revealed that lower number of enrolled participants (e.g., 1-10) per site, the presence of pre-operative acidosis, increased circulatory arrest time, the occurrence of a central line infection, and the development of respiratory insufficiency requiring re-intubation were associated with prolonged LOS in the ICU. Prolonged LOS in the ICU following Stage I palliation in patients with HLHS and HLHS variant anatomy is associated with site enrollment, circulatory arrest time, pre-operative acidosis, and some post-operative complications, including central line infection and re-intubation. Further study of these associations may reveal strategies for reducing LOS in the ICU following the Norwood and Norwood-variant surgeries.

Original languageEnglish (US)
Pages (from-to)431-440
Number of pages10
JournalPediatric Cardiology
Volume35
Issue number3
DOIs
StatePublished - Jan 1 2014

Fingerprint

Quality Improvement
Cardiology
Intensive Care Units
Length of Stay
Hypoplastic Left Heart Syndrome
Pediatrics
Acidosis
Intubation
Multivariate Analysis
Operative Time
Infection
Respiratory Insufficiency
Registries
Heart Diseases
Anatomy
Joints

Keywords

  • Hypoplastic left heart syndrome
  • Length of stay
  • Norwood procedure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of prolonged length of intensive care unit stay after stage i palliation : A report from the National Pediatric Cardiology Quality Improvement Collaborative. / Baker-Smith, Carissa M.; Wilhelm, Carolyn M.; Neish, Steven R.; Klitzner, Thomas S.; Beekman, Robert H.; Kugler, John Dale; Martin, Gerard R.; Lannon, Carole; Jenkins, Kathy J.; Rosenthal, Geoffrey L.

In: Pediatric Cardiology, Vol. 35, No. 3, 01.01.2014, p. 431-440.

Research output: Contribution to journalArticle

Baker-Smith, CM, Wilhelm, CM, Neish, SR, Klitzner, TS, Beekman, RH, Kugler, JD, Martin, GR, Lannon, C, Jenkins, KJ & Rosenthal, GL 2014, 'Predictors of prolonged length of intensive care unit stay after stage i palliation: A report from the National Pediatric Cardiology Quality Improvement Collaborative', Pediatric Cardiology, vol. 35, no. 3, pp. 431-440. https://doi.org/10.1007/s00246-013-0797-y
Baker-Smith, Carissa M. ; Wilhelm, Carolyn M. ; Neish, Steven R. ; Klitzner, Thomas S. ; Beekman, Robert H. ; Kugler, John Dale ; Martin, Gerard R. ; Lannon, Carole ; Jenkins, Kathy J. ; Rosenthal, Geoffrey L. / Predictors of prolonged length of intensive care unit stay after stage i palliation : A report from the National Pediatric Cardiology Quality Improvement Collaborative. In: Pediatric Cardiology. 2014 ; Vol. 35, No. 3. pp. 431-440.
@article{04de9b717f734fc798460b4b22c1667a,
title = "Predictors of prolonged length of intensive care unit stay after stage i palliation: A report from the National Pediatric Cardiology Quality Improvement Collaborative",
abstract = "The objective of this study is to identify predictors of prolonged intensive care unit (ICU) length of stay (LOS) for single ventricle patients following Stage I palliation. We hypothesize that peri-operative factors contribute to prolonged ICU stay among children with hypoplastic left heart syndrome (HLHS) and its variants. In 2008, as a part of the Joint Council on Congenital Heart Disease initiative, the National Pediatric Cardiology-Quality Improvement Collaborative established a data registry for patients with HLHS and its variants undergoing staged palliation. Between July 2008 and August 2011, 33 sites across the United States submitted discharge data essential to this analysis. Data describing the patients, their procedures, and their hospital experience were entered. LOS estimates were generated. Prolonged LOS in the ICU was defined as stay greater than or equal to 26 days (i.e., 75th percentile). Statistical analyses were carried out to identify pre-operative, operative, and post-operative predictors of prolonged LOS in the ICU. The number of patients with complete discharge data was 303, and these subjects were included in the analysis. Univariate and multivariate analyses were performed. Multivariate analysis revealed that lower number of enrolled participants (e.g., 1-10) per site, the presence of pre-operative acidosis, increased circulatory arrest time, the occurrence of a central line infection, and the development of respiratory insufficiency requiring re-intubation were associated with prolonged LOS in the ICU. Prolonged LOS in the ICU following Stage I palliation in patients with HLHS and HLHS variant anatomy is associated with site enrollment, circulatory arrest time, pre-operative acidosis, and some post-operative complications, including central line infection and re-intubation. Further study of these associations may reveal strategies for reducing LOS in the ICU following the Norwood and Norwood-variant surgeries.",
keywords = "Hypoplastic left heart syndrome, Length of stay, Norwood procedure",
author = "Baker-Smith, {Carissa M.} and Wilhelm, {Carolyn M.} and Neish, {Steven R.} and Klitzner, {Thomas S.} and Beekman, {Robert H.} and Kugler, {John Dale} and Martin, {Gerard R.} and Carole Lannon and Jenkins, {Kathy J.} and Rosenthal, {Geoffrey L.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s00246-013-0797-y",
language = "English (US)",
volume = "35",
pages = "431--440",
journal = "Pediatric Cardiology",
issn = "0172-0643",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Predictors of prolonged length of intensive care unit stay after stage i palliation

T2 - A report from the National Pediatric Cardiology Quality Improvement Collaborative

AU - Baker-Smith, Carissa M.

AU - Wilhelm, Carolyn M.

AU - Neish, Steven R.

AU - Klitzner, Thomas S.

AU - Beekman, Robert H.

AU - Kugler, John Dale

AU - Martin, Gerard R.

AU - Lannon, Carole

AU - Jenkins, Kathy J.

AU - Rosenthal, Geoffrey L.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - The objective of this study is to identify predictors of prolonged intensive care unit (ICU) length of stay (LOS) for single ventricle patients following Stage I palliation. We hypothesize that peri-operative factors contribute to prolonged ICU stay among children with hypoplastic left heart syndrome (HLHS) and its variants. In 2008, as a part of the Joint Council on Congenital Heart Disease initiative, the National Pediatric Cardiology-Quality Improvement Collaborative established a data registry for patients with HLHS and its variants undergoing staged palliation. Between July 2008 and August 2011, 33 sites across the United States submitted discharge data essential to this analysis. Data describing the patients, their procedures, and their hospital experience were entered. LOS estimates were generated. Prolonged LOS in the ICU was defined as stay greater than or equal to 26 days (i.e., 75th percentile). Statistical analyses were carried out to identify pre-operative, operative, and post-operative predictors of prolonged LOS in the ICU. The number of patients with complete discharge data was 303, and these subjects were included in the analysis. Univariate and multivariate analyses were performed. Multivariate analysis revealed that lower number of enrolled participants (e.g., 1-10) per site, the presence of pre-operative acidosis, increased circulatory arrest time, the occurrence of a central line infection, and the development of respiratory insufficiency requiring re-intubation were associated with prolonged LOS in the ICU. Prolonged LOS in the ICU following Stage I palliation in patients with HLHS and HLHS variant anatomy is associated with site enrollment, circulatory arrest time, pre-operative acidosis, and some post-operative complications, including central line infection and re-intubation. Further study of these associations may reveal strategies for reducing LOS in the ICU following the Norwood and Norwood-variant surgeries.

AB - The objective of this study is to identify predictors of prolonged intensive care unit (ICU) length of stay (LOS) for single ventricle patients following Stage I palliation. We hypothesize that peri-operative factors contribute to prolonged ICU stay among children with hypoplastic left heart syndrome (HLHS) and its variants. In 2008, as a part of the Joint Council on Congenital Heart Disease initiative, the National Pediatric Cardiology-Quality Improvement Collaborative established a data registry for patients with HLHS and its variants undergoing staged palliation. Between July 2008 and August 2011, 33 sites across the United States submitted discharge data essential to this analysis. Data describing the patients, their procedures, and their hospital experience were entered. LOS estimates were generated. Prolonged LOS in the ICU was defined as stay greater than or equal to 26 days (i.e., 75th percentile). Statistical analyses were carried out to identify pre-operative, operative, and post-operative predictors of prolonged LOS in the ICU. The number of patients with complete discharge data was 303, and these subjects were included in the analysis. Univariate and multivariate analyses were performed. Multivariate analysis revealed that lower number of enrolled participants (e.g., 1-10) per site, the presence of pre-operative acidosis, increased circulatory arrest time, the occurrence of a central line infection, and the development of respiratory insufficiency requiring re-intubation were associated with prolonged LOS in the ICU. Prolonged LOS in the ICU following Stage I palliation in patients with HLHS and HLHS variant anatomy is associated with site enrollment, circulatory arrest time, pre-operative acidosis, and some post-operative complications, including central line infection and re-intubation. Further study of these associations may reveal strategies for reducing LOS in the ICU following the Norwood and Norwood-variant surgeries.

KW - Hypoplastic left heart syndrome

KW - Length of stay

KW - Norwood procedure

UR - http://www.scopus.com/inward/record.url?scp=84897603010&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897603010&partnerID=8YFLogxK

U2 - 10.1007/s00246-013-0797-y

DO - 10.1007/s00246-013-0797-y

M3 - Article

VL - 35

SP - 431

EP - 440

JO - Pediatric Cardiology

JF - Pediatric Cardiology

SN - 0172-0643

IS - 3

ER -