Skip to main content

Advertisement

SpringerLink
Log in

Risk Factors for Increased Post-operative Length of Stay in Children with Coarctation of Aorta

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Coarctation of the aorta is a relatively common congenital heart disease occurring in 0.4–0.6 per 1000 live births with a low mortality rate. This is a retrospective study, with data abstracted from the Pediatric Health Information System database (PHIS). The study sample included pediatric patients less than or equal to 3 months of age discharged from a PHIS participating hospital between January 1, 2004 and December 31, 2018 who underwent surgical repair of isolated COA. The primary outcome for the study was post-operative hospital length of stay (PH-LOS), and the secondary outcome was in-hospital mortality. Patient demographics, comorbidities, procedures, and outcomes were assessed for statistical differences between eras. A total of 5354 patients were included in the study. The study highlights an increasing trend in PH-LOS and NICU hospital length of stay (NICU-LOS) across the investigated eras. Prematurity (before 37 weeks gestation) was an independent risk factor associated with both longer post-operative length of the stay and higher mortality. In addition, congenital anomalies, respiratory and abdominal surgeries have a significant impact on the post-operative hospital stay. In conclusion, this study is the largest published systematic assessment of PH-LOS in patients with isolated COA repair during infancy to date and identifies independent risk factors of increased PH-LOS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Code availability

Are available.

Data Availability

Not available or none will be deposited.

References

  1. Eichhorn JG, Ley S, Kropp F et al (2019) Aortic coarctation a systemic vessel disease-insights from magnetic resonance imaging. Thorac Cardiovasc Surg 67(S04):1–10. https://doi.org/10.1055/s-0039-1697915

    Article  Google Scholar 

  2. Wu Y, Li J, Wu C et al (2020) Diagnosis and surgical repair for coarctation of the aorta with intracardiac defects: a single center experience based on 93 infants. Front Pediatr 8:49. https://doi.org/10.3389/fped.2020.00049

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dijkema EJ, Leiner T, Grotenhuis HB (2017) Diagnosis, imaging and clinical management of aortic coarctation. Heart 103(15):1148–1155. https://doi.org/10.1136/heartjnl-2017-311173

    Article  PubMed  Google Scholar 

  4. Rodes-Cabau J, Miro J, Dancea A et al (2007) Comparison of surgical and transcatheter treatment for native coarctation of the aorta in patients > or = 1 year old The Quebec Native Coarctation of the Aorta study. Am Heart J 154(1):186–192. https://doi.org/10.1016/j.ahj.2007.03.046

    Article  PubMed  Google Scholar 

  5. Ij R, Liu H, Pigula F et al (2019) Rates of interventions in isolated coarctation repair in neonates versus infants does age matter? Ann Thorac Surg 107(1):180–186. https://doi.org/10.1016/j.athoracsur.2018.07.016

    Article  Google Scholar 

  6. Evers PD, Ranade D, Lewin M, Arya B (2017) Diagnostic approach in fetal coarctation of the aorta: a cost-utility analysis. J Am Soc Echocardiogr 30(6):589–594. https://doi.org/10.1016/j.echo.2017.01.019

    Article  PubMed  Google Scholar 

  7. Tulzer A, Mair R, Kreuzer M, Tulzer G (2016) Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg 152(6):1506–1513. https://doi.org/10.1016/j.jtcvs.2016.08.029

    Article  PubMed  Google Scholar 

  8. Shim D, Lloyd TR, Moorehead CP, Bove EL, Mosca RS, Beekman RH 3rd (1997) Comparison of hospital charges for balloon angioplasty and surgical repair in children with native coarctation of the aorta. Am J Cardiol 79(8):1143–1146. https://doi.org/10.1016/s0002-9149(97)00068-4

    Article  CAS  PubMed  Google Scholar 

  9. St Louis JD, Harvey BA, Menk JS, O’Brien JE Jr, Kochilas LK (2015) Mortality and operative management for patients undergoing repair of coarctation of the aorta: a retrospective review of the pediatric cardiac care consortium. World J Pediatr Congenit Heart Surg 6(3):431–437. https://doi.org/10.1177/2150135115590458

    Article  PubMed  Google Scholar 

  10. Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, Moll JJ (2011) Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg 40(1):179–184. https://doi.org/10.1016/j.ejcts.2010.11.038

    Article  PubMed  Google Scholar 

  11. Liu M, Druschel CM, Hannan EL (2014) Risk-adjusted prolonged length of stay as an alternative outcome measure for pediatric congenital cardiac surgery. Ann Thorac Surg 97(6):2154–2159. https://doi.org/10.1016/j.athoracsur.2013.11.008

    Article  CAS  PubMed  Google Scholar 

  12. Shabana, A. Bicuspid aortic valve. e-Journal of Cardiology Practice. Vol. 13, N° 2 - 26 Sep 2014

  13. Pappas A, Shankaran S, Hansen NI et al (2012) outcome of extremely preterm infants (<1000 g) with congenital heart defects from the national institute of child health and human development neonatal research network. Pediatr Cardiol 33(8):1415–1426. https://doi.org/10.1007/s00246-012-0375-8

    Article  PubMed  PubMed Central  Google Scholar 

  14. Khodaghalian B, Subhedar NV, Chikermane A (2019) Prostaglandin E 2 in a preterm infant with coarctation of the aorta. BMJ Case Rep 12(9):230910. https://doi.org/10.1136/bcr-2019-230910

    Article  Google Scholar 

  15. Desai J, Aggarwal S, Lipshultz S et al (2017) Surgical interventions in infants born preterm with congenital heart defects: an analysis of the kids’ inpatient database. J Pediatr 191(103–109):e4. https://doi.org/10.1016/j.jpeds.2017.07.015

    Article  Google Scholar 

  16. Bacha EA, Almodovar M, Wessel DL et al (2001) surgery for coarctation of the aorta in infants weighing less than 2 kg. Ann Thorac Surg 71(4):1260–1264. https://doi.org/10.1016/s0003-4975(00)02664-3

    Article  CAS  PubMed  Google Scholar 

  17. Burch PT, Cowley CG, Holubkov R et al (2009) Coarctation repair in neonates and young infants:is small size or low weight still a risk factor? J Thorac Cardiovasc Surg 138(3):547–552. https://doi.org/10.1016/j.jtcvs.2009.04.046

    Article  PubMed  Google Scholar 

  18. Sudarshan CD, Cochrane AD, Jun ZH, Soto R, Brizard CP (2006) Repair of coarctation of the aorta in infants weighing less than 2 kilograms. Ann Thorac Surg 82(1):158–163. https://doi.org/10.1016/j.athoracsur.2006.03.007

    Article  PubMed  Google Scholar 

  19. Bansal N, Balakrishnan PL, Aggarwal S (2019) Prostaglandin infusion in neonate with severe coarctation of the aorta with closed ductus arteriosus-a case report and review of the literature. World J Pediatr Congenit Heart Surg. https://doi.org/10.1177/2150135118799635

    Article  PubMed  Google Scholar 

  20. Costello JM, McQuillen PS, Claud EC, Steinhorn RH (2011) Prematurity and congenital heart disease. World J Pediatr Congenit Heart Surg 2(3):457–467. https://doi.org/10.1177/2150135111408445

    Article  PubMed  Google Scholar 

  21. Dharmapuram AK, Ramadoss N, Verma S, Vejendla G, Ivatury RM (2018) Early outcomes of modification of end to side repair of coarctation of aorta with arch hypoplasia in neonates and infants. Ann Pediatr Card 11:267–274. https://doi.org/10.4103/apc.APC_5_18

    Article  Google Scholar 

  22. Said SM et al (2014) Ascending-to-descending aortic bypass: a simple solution to a complex problem. Ann Thorac Surg 97(6):2041–2047. https://doi.org/10.1016/j.athoracsur.2014.02.030

    Article  PubMed  Google Scholar 

  23. Benneyworth BD, Shao JM, Cristea AI et al (2016) Tracheostomy following surgery for congenital heart disease: a 14-year institutional experience. World J Pediatr Congenit Heart Surg 7(3):360–366. https://doi.org/10.1177/2150135116644432

    Article  PubMed  Google Scholar 

  24. Prodhan P, Agarwal A, ElHassan NO et al (2017) Tracheostomy among infants with hypoplastic left heart syndrome undergoing cardiac operations: a multicenter analysis. Ann Thorac Surg 103(4):1308–1314. https://doi.org/10.1016/j.athoracsur.2016.09.016

    Article  PubMed  Google Scholar 

  25. Mastropietro CW, Benneyworth BD, Turrentine M et al (2016) Tracheostomy after operations for congenital heart disease: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 101(6):2285–2292. https://doi.org/10.1016/j.athoracsur.2016.01.046

    Article  PubMed  Google Scholar 

  26. Maxwell BG, McMillan KN (2014) Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database. PeerJ 2:e568. https://doi.org/10.7717/peerj.568

    Article  PubMed  PubMed Central  Google Scholar 

  27. Piggott KD, Babb J, Yong S et al (2018) Risk factors for gastrostomy tube placement in single ventricle patients following the norwood procedure. Semin Thorac Cardiovasc Surg Winter 30(4):443–447. https://doi.org/10.1053/j.semtcvs.2018.02.012

    Article  Google Scholar 

  28. McKean EB, Kasparian NA, Batra S, Sholler GF, Winlaw DS, Dalby-Payne J (2017) Feeding difficulties in neonates following cardiac surgery: determinants of prolonged feeding-tube use. Cardiol Young 27(6):1203–1211. https://doi.org/10.1017/S1047951116002845

    Article  PubMed  Google Scholar 

  29. Rossi AF, Fishberger S, Hannan RL et al (2009) Frequency and indications for tracheostomy and gastrostomy after congenital heart surgery. Pediatr Cardiol 30(3):225–231. https://doi.org/10.1007/s00246-008-9324-y

    Article  PubMed  Google Scholar 

  30. Kemper AR, Mahle WT, Martin GR et al (2011) Strategies for implementing screening for critical congenital heart disease. Pediatrics 128(5):e1259–e1267

    Article  Google Scholar 

Download references

Funding

No external funding for this manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatrics (Cardiology and Pediatric Intensive Care), University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, 1 Children’s Way, Slot 512-1, Little Rock, AR, 72202, USA

    Laura Schoeneberg, Parthak Prodhan & Dala Zakaria

  2. Arkansas Children’s Research Institute (Biostatistics), Little Rock, USA

    Beverly Spray & Chary Akmyradov

Authors
  1. Laura Schoeneberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Parthak Prodhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beverly Spray
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chary Akmyradov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dala Zakaria
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S, Z, and P conceptualized and designed the study, designed the data collection instruments, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. S and A carried out the initial analyses and reviewed and revised the manuscript.

Corresponding author

Correspondence to Dala Zakaria.

Ethics declarations

Conflict of interest

The authors have no potential conflicts of interest to disclose.

Ethical approval

The IRB for University of Arkansas Medical Sciences deemed this exempt as it is a de-identified database.

Consent for publication

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

246_2021_2641_MOESM1_ESM.tiff

Supplementary file1 Percentage of Patients with Coarctation of the Aorta who Received an MRI, Catheterization, or CT scan. CA: Catheterization, M: MRI, CT: Computed tomography (TIFF 2453 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schoeneberg, L., Prodhan, P., Spray, B. et al. Risk Factors for Increased Post-operative Length of Stay in Children with Coarctation of Aorta. Pediatr Cardiol 42, 1567–1574 (2021). https://doi.org/10.1007/s00246-021-02641-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-021-02641-x

Keywords

Search

Navigation