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Am J Perinatol 2015; 32(12): 1133-1138
DOI: 10.1055/s-0035-1549215
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rehospitalization Following Neonatal Cardiac Surgery: Risk Factors and Outcomes

Amira Soliman
1   Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
,
Sanjeev Aggarwal
1   Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
,
Girija Natarajan
1   Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
› Author Affiliations
Further Information

Publication History

31 July 2014

28 February 2015

Publication Date:
08 May 2015 (online)

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Abstract

Objective The aim of the study is to determine the number and indications of unplanned hospital readmissions and emergency room visits for children with hypoplastic left heart syndrome (HLHS) or transposition of great arteries (TGA).

Design This retrospective chart review involved children with HLHS or TGA who underwent neonatal surgical repair in a single Children's Hospital. Statistical analysis (SPSS 22.0) included chi-square test, t-test, and binary logistic regression.

Results Our study cohort (n = 117) comprised 28 children with HLHS and 89 with TGA who were followed for a mean (standard deviation, SD) duration of 4.7 (3.2) years. Unplanned readmissions (n = 153) occurred in 46 (39.3%) children, a mean (SD) number of 1.3 (2.8) for a median (interquartile range, IQR) of 8 (2–28) days per patient. Indications were respiratory (57.5%), gastrointestinal (18.3%), and cardiac (12.4%) in nature. On binary regression, with birth weight, race, and gestational age as covariates, among children with HLHS, increasing gestational age tended to be associated with a lower risk of readmissions (odds ratio [OR] 0.138; 95% confidence interval [CI]: 0.018–1.031, p = 0.054]. The mean (SD) number of emergency room visits (n = 261) was 3.2 (9.7) in 42 (35.9%) infants for minor illnesses (64%) or gastrointestinal (13.8%) problems.

Conclusion The majority of children with HLHS and TGA have unplanned readmissions. Home-care surveillance programs may reduce health-care utilization in this population.

Keywords

rehospitalization - hypoplastic left heart syndrome - transposition of great arteries
 

  • Reference

  • 1 Berry JG, Toomey SL, Zaslavsky AM , et al. Pediatric readmission prevalence and variability across hospitals. JAMA 2013; 309 (4) 372-380
    CrossrefPubMedSearch in Google Scholar
  • 2 Bardach NS, Vittinghoff E, Asteria-Peñaloza R , et al. Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics 2013; 132 (3) 429-436
    CrossrefPubMedSearch in Google Scholar
  • 3 Berry JG, Hall DE, Kuo DZ , et al. Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals. JAMA 2011; 305 (7) 682-690
    CrossrefPubMedSearch in Google Scholar
  • 4 Feudtner C, Levin JE, Srivastava R , et al. How well can hospital readmission be predicted in a cohort of hospitalized children? A retrospective, multicenter study. Pediatrics 2009; 123 (1) 286-293
    CrossrefPubMedSearch in Google Scholar
  • 5 Feudtner C, Pati S, Goodman DM , et al. State-level child health system performance and the likelihood of readmission to children's hospitals. J Pediatr 2010; 157 (1) 98-102.e1
    CrossrefPubMedSearch in Google Scholar
  • 6 Jen HC, Shew SB. Hospital readmissions and survival after nonneonatal pediatric ECMO. Pediatrics 2010; 125 (6) 1217-1223
    CrossrefPubMedSearch in Google Scholar
  • 7 Ambalavanan N, Carlo WA, McDonald SA, Yao Q, Das A, Higgins RD ; Generic Database and Follow-up Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Identification of extremely premature infants at high risk of rehospitalization. Pediatrics 2011; 128 (5) e1216-e1225
    CrossrefPubMedSearch in Google Scholar
  • 8 Visitsunthorn N, Lilitwat W, Jirapongsananuruk O, Vichyanond P. Factors affecting readmission for acute asthmatic attacks in children. Asian Pac J Allergy Immunol 2013; 31 (2) 138-141
    PubMedSearch in Google Scholar
  • 9 Ralser E, Mueller W, Haberland C , et al. Rehospitalization in the first 2 years of life in children born preterm. Acta Paediatr 2012; 101 (1) e1-e5
    CrossrefPubMedSearch in Google Scholar
  • 10 Sistino JJ, Bonilha HS. Improvements in survival and neurodevelopmental outcomes in surgical treatment of hypoplastic left heart syndrome: a meta-analytic review. J Extra Corpor Technol 2012; 44 (4) 216-223
    PubMedSearch in Google Scholar
  • 11 Villafañe J, Lantin-Hermoso MR, Bhatt AB , et al; American College of Cardiology's Adult Congenital and Pediatric Cardiology Council. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol 2014; 64 (5) 498-511
    CrossrefPubMedSearch in Google Scholar
  • 12 Mackie AS, Ionescu-Ittu R, Pilote L, Rahme E, Marelli AJ. Hospital readmissions in children with congenital heart disease: a population-based study. Am Heart J 2008; 155 (3) 577-584
    CrossrefPubMedSearch in Google Scholar
  • 13 Natarajan G, Reddy Anne S, Aggarwal S. Enteral feeding of neonates with congenital heart disease. Neonatology 2010; 98 (4) 330-336
    CrossrefPubMedSearch in Google Scholar
  • 14 Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012; 24 (2) 191-196
    CrossrefPubMedSearch in Google Scholar
  • 15 Eghtesady P, Brar AK, Hall M. Prioritizing quality improvement in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2013; 145 (3) 631-639 , discussion 639–640
    CrossrefPubMedSearch in Google Scholar
  • 16 Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC. Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg 2004; 78 (6) 1972-1978 , discussion 1978
    CrossrefPubMedSearch in Google Scholar
  • 17 Challapudi G, Natarajan G, Aggarwal S. Single-center experience of outcomes of tracheostomy in children with congenital heart disease. Congenit Heart Dis 2013; 8 (6) 556-560
    CrossrefPubMedSearch in Google Scholar
  • 18 Costello JM, Pasquali SK, Jacobs JP , et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 2014; 129 (24) 2511-2517
    CrossrefPubMedSearch in Google Scholar
  • 19 National Center for Health Statistics. Health, United States, 2012: With Special Feature on Emergency Care. Health, United States, 2012; 2013
  • 20 Hsia RY, Nath JB, Baker LC. Emergency department visits by children, adolescents, and young adults in California by insurance status, 2005-2010. JAMA 2014; 312 (15) 1587-1588
    CrossrefPubMedSearch in Google Scholar
  • 21 Menon SC, Keenan HT, Weng HY , et al. Outcome and resource utilization of infants born with hypoplastic left heart syndrome in the Intermountain West. Am J Cardiol 2012; 110 (5) 720-727
    CrossrefPubMedSearch in Google Scholar
  • 22 Bishop NB, Zhou TX, Chen JM, Ward MJ, Carroll SJ. The impact of gestational age on resource utilization after open heart surgery for congenital cardiac disease from birth to 1 year of age. Pediatr Cardiol 2013; 34 (3) 686-693
    CrossrefPubMedSearch in Google Scholar
  • 23 Wang Y, Liu G, Druschel CM, Kirby RS. Maternal race/ethnicity and survival experience of children with congenital heart disease. J Pediatr 2013; 163 (5) 1437-42.e1 , 2
    CrossrefPubMedSearch in Google Scholar
  • 24 Azakie T, Merklinger SL, McCrindle BW , et al. Evolving strategies and improving outcomes of the modified Norwood procedure: a 10-year single-institution experience. Ann Thorac Surg 2001; 72 (4) 1349-1353
    CrossrefPubMedSearch in Google Scholar
  • 25 Hehir DA, Dominguez TE, Ballweg JA , et al. Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 2008; 136 (1) 94-99 , 99.e1–99.e3
    CrossrefPubMedSearch in Google Scholar
  • 26 McGuirk SP, Griselli M, Stumper OF , et al. Staged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience. Heart 2006; 92 (3) 364-370
    PubMedSearch in Google Scholar
  • 27 Tweddell JS, Hoffman GM, Mussatto KA , et al. Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 2002; 106 (12) (Suppl. 01) I82-I89
    PubMedSearch in Google Scholar
  • 28 Hansen JH, Furck AK, Petko C , et al. Use of surveillance criteria reduces interstage mortality after the Norwood operation for hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2012; 41 (5) 1013-1018
    CrossrefPubMedSearch in Google Scholar
  • 29 Hehir DA, Cooper DS, Walters EM, Ghanayem NS. Feeding, growth, nutrition, and optimal interstage surveillance for infants with hypoplastic left heart syndrome. Cardiol Young 2011; 21 (Suppl. 02) 59-64
    CrossrefPubMedSearch in Google Scholar
  • 30 Miller-Tate H, Stewart J, Allen R , et al. Interstage weight gain for patients with hypoplastic left heart syndrome undergoing the hybrid procedure. Congenit Heart Dis 2013; 8 (3) 228-233
    CrossrefPubMedSearch in Google Scholar
  • 31 Pasquali SK, Ohye RG, Lu M , et al; Pediatric Heart Network Investigators. Variation in perioperative care across centers for infants undergoing the Norwood procedure. J Thorac Cardiovasc Surg 2012; 144 (4) 915-921
    CrossrefPubMedSearch in Google Scholar