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Variation in care for infants undergoing the Stage II palliation for hypoplastic left heart syndrome

Part of: Pediatric Heart Network

Published online by Cambridge University Press:  24 July 2018

Aaron Eckhauser ,
Sara K. Pasquali ,
Chitra Ravishankar ,
Linda M. Lambert ,
Jane W. Newburger ,
Andrew M. Atz ,
Nancy Ghanayem ,
Steven M. Schwartz ,
Chong Zhang  and
Jeffery P. Jacobs
...Show all authors
Aaron Eckhauser*
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
Sara K. Pasquali
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
Chitra Ravishankar
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Linda M. Lambert
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
Jane W. Newburger
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Andrew M. Atz
Affiliation:
Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
Nancy Ghanayem
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Steven M. Schwartz
Affiliation:
Departments of Critical Care Medicine and Paediatrics, Divisions of Cardiac Critical Care Medicine and Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, CA, USA
Chong Zhang
Affiliation:
Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
Jeffery P. Jacobs
Affiliation:
Department of Surgery, Division of Cardiovascular Surgery, John’s Hopkins University, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
L. LuAnn Minich
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
*
Author for correspondence: A. Eckhauser, MD, MS, Division of Pediatric Cardiothoracic Surgery, University of Utah, 100 N. Mario Capecchi Dr, Suite 2200, Salt Lake City, UT 84113, USA. Tel: 801 662 5566; Fax: 801 662 5571; E-mail: aaron.eckhauser@hsc.utah.edu
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Abstract

Background

The Single Ventricle Reconstruction trial randomised neonates with hypoplastic left heart syndrome to a systemic-to-pulmonary-artery shunt strategy. Patients received care according to usual institutional practice. We analysed practice variation at the Stage II surgery to attempt to identify areas for decreased variation and process control improvement.

Methods

Prospectively collected data were available in the Single Ventricle Reconstruction public-use database. Practice variation across 14 centres was described for 397 patients who underwent Stage II surgery. Data are centre-level specific and reported as interquartile ranges across all centres, unless otherwise specified.

Results

Preoperative Stage II median age and weight across centres were 5.4 months (interquartile range 4.9–5.7) and 5.7 kg (5.5–6.1), with 70% performed electively. Most patients had pre-Stage-II cardiac catheterisation (98.5–100%). Digoxin was used by 11/14 centres in 25% of patients (23–31%), and 81% had some oral feeds (68–84%). The majority of the centres (86%) performed a bidirectional Glenn versus hemi-Fontan. Median cardiopulmonary bypass time was 96 minutes (75–113). In aggregate, 26% of patients had deep hypothermic circulatory arrest >10 minutes. In 13/14 centres using deep hypothermic circulatory arrest, 12.5% of patients exceeded 10 minutes (8–32%). Seven centres extubated 5% of patients (2–40) in the operating room. Postoperatively, ICU length of stay was 4.8 days (4.0–5.3) and total length of stay was 7.5 days (6–10).

Conclusions

In the Single Ventricle Reconstruction Trial, practice varied widely among centres for nearly all perioperative factors surrounding Stage II. Further analysis may facilitate establishing best practices by identifying the impact of practice variation.

Keywords

ClassificationsFontanhypoplastic left heart syndromeperioperative carequality caremanagement
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 10 , October 2018 , pp. 1109 - 1115
Copyright
© Cambridge University Press 2018 

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