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Factors Associated with Inability to Discharge After Stage 1 Palliation for Single Ventricle Heart Disease: An Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database

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Abstract

Patient-level characteristics associated with survival for single ventricle heart disease following initial staged palliation have been described. However, the impact of peri-operative events on hospital discharge has not been examined. To characterize patient-level characteristics and peri-operative events that were associated with inability to be discharged after Stage 1 palliation (S1P). Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Dataset including patients who underwent a S1P procedure between 2016 and 2019 (Norwood or Hybrid Stage 1 procedure). We examined patient-level characteristics and peri-operative events as possible predictors of inability to discharge after S1P. We constructed multivariate logistic regression models examining post-S1P discharge and in-hospital mortality, adjusting for covariates. 843 patients underwent a S1P and 717 (85%) patients were discharged home or remained inpatient until Stage 2 for social but not medical concerns. Moderate or greater pre-operative atrioventricular valve regurgitation (odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8–12), presence of high-risk pre-operative adverse events (OR 1.5, 95%CI 1.0–2.3), peri-operative events: temporary dialysis (OR 5.4, 95%CI 1.5–18.9), cardiac catheterization or cardiac surgery (OR 2.9, 95%CI 1.8–4.6), sepsis (OR 2.7, 95%CI 1.2–6.2), junctional tachycardia (OR 2.6, 95%CI 1.0–6.3), necrotizing enterocolitis (OR 2.6, 95%CI 1.3–5.2), ECMO (OR 2.5, 95%CI 1.4–4.3), neurological injury (OR 2.1, 95%CI 1.1–4.1), and re-intubation (OR 1.8, 95%CI 1.1–2.9) were associated with inability to discharge after Stage 1. Cardiac anatomical factors, pre-operative adverse events, post-operative re-intubation, post-operative ECMO, infectious complications, and unplanned catheter or surgical re-interventions were associated with inability to discharge after S1P. These findings suggest that quality improvement efforts aimed at reducing these peri-operative events may improve Stage 1 survival and likelihood of discharge.

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Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine and Cardiology, Department of Pediatrics, University of Washington/Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Andrea Otero Luna & Titus Chan

  2. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

    Pierce Kuhnell

  3. James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

    Sharyl Wooton

  4. Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, USA

    Stephanie S. Handler

  5. Pediatric Cardiology, Department of Pediatrics, Santa Clara Valley Health and Hospital System, San Jose, CA, USA

    Gail Wright

  6. Cardiothoracic Surgery, Helen DeVos Children’s Hospital, Grand Rapids, MI, USA

    James Hammel

  7. Division of Cardiothoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, USA

    James S. Tweddell

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  1. Andrea Otero Luna
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  2. Pierce Kuhnell
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  3. Sharyl Wooton
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  4. Stephanie S. Handler
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  6. James Hammel
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  7. James S. Tweddell
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  8. Titus Chan
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Correspondence to Andrea Otero Luna.

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Luna, A.O., Kuhnell, P., Wooton, S. et al. Factors Associated with Inability to Discharge After Stage 1 Palliation for Single Ventricle Heart Disease: An Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database. Pediatr Cardiol 43, 1298–1310 (2022). https://doi.org/10.1007/s00246-022-02852-w

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  • DOI: https://doi.org/10.1007/s00246-022-02852-w

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