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Care models and associated outcomes in congenital heart surgery.

Publication ,  Journal Article
Burstein, DS; Jacobs, JP; Li, JS; Sheng, S; O'Brien, SM; Rossi, AF; Checchia, PA; Wernovsky, G; Welke, KF; Peterson, ED; Jacobs, ML; Pasquali, SK
Published in: Pediatrics
June 2011

OBJECTIVE: Recently, there has been a shift toward care of children undergoing heart surgery in dedicated pediatric cardiac intensive care units (CICU). The impact of this trend on patient outcomes is unclear. We evaluated postoperative outcomes associated with a CICU versus other ICU models. PATIENTS AND METHODS: Society of Thoracic Surgeons Congenital Heart Surgery Database participants (2007-2009) who completed an ICU survey were included. In multivariable analysis, we evaluated outcomes associated with a CICU versus other ICUs, adjusting for center volume, patient factors, and Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery surgical risk category. RESULTS: A total of 20 922 patients (47 centers; 25 with a CICU) were included. Overall unadjusted mortality was 3.8%, median length of stay was 6 days (interquartile range: 4-13), and 21% had 1 or more complications. In multivariable analysis, there was no difference in mortality comparing CICUs versus other ICUs (odds ratio: 0.88 [95% confidence interval: 0.65-1.19]). In stratified analysis, CICUs were associated with lower mortality only among those in Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category 3 (odds ratio: 0.47 [95% confidence interval: 0.25-0.86]), primarily related to atrioventricular canal repair and arterial switch operation. There was no difference in length of stay or complications overall or in stratified analysis. CONCLUSIONS: We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .

Duke Scholars

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

June 2011

Volume

127

Issue

6

Start / End Page

e1482 / e1489

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pediatrics
  • Outcome Assessment, Health Care
  • Male
  • Length of Stay
  • Intensive Care Units, Pediatric
  • Infant, Newborn
  • Infant
  • Humans
  • Heart Defects, Congenital
 

Citation

APA
Chicago
ICMJE
MLA
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Burstein, D. S., Jacobs, J. P., Li, J. S., Sheng, S., O’Brien, S. M., Rossi, A. F., … Pasquali, S. K. (2011). Care models and associated outcomes in congenital heart surgery. Pediatrics, 127(6), e1482–e1489. https://doi.org/10.1542/peds.2010-2796
Burstein, Danielle S., Jeffrey P. Jacobs, Jennifer S. Li, Shubin Sheng, Sean M. O’Brien, Anthony F. Rossi, Paul A. Checchia, et al. “Care models and associated outcomes in congenital heart surgery.Pediatrics 127, no. 6 (June 2011): e1482–89. https://doi.org/10.1542/peds.2010-2796.
Burstein DS, Jacobs JP, Li JS, Sheng S, O’Brien SM, Rossi AF, et al. Care models and associated outcomes in congenital heart surgery. Pediatrics. 2011 Jun;127(6):e1482–9.
Burstein, Danielle S., et al. “Care models and associated outcomes in congenital heart surgery.Pediatrics, vol. 127, no. 6, June 2011, pp. e1482–89. Pubmed, doi:10.1542/peds.2010-2796.
Burstein DS, Jacobs JP, Li JS, Sheng S, O’Brien SM, Rossi AF, Checchia PA, Wernovsky G, Welke KF, Peterson ED, Jacobs ML, Pasquali SK. Care models and associated outcomes in congenital heart surgery. Pediatrics. 2011 Jun;127(6):e1482–e1489.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

June 2011

Volume

127

Issue

6

Start / End Page

e1482 / e1489

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pediatrics
  • Outcome Assessment, Health Care
  • Male
  • Length of Stay
  • Intensive Care Units, Pediatric
  • Infant, Newborn
  • Infant
  • Humans
  • Heart Defects, Congenital