Care models and associated outcomes in congenital heart surgery

• Published in: Pediatrics (Evanston) 2011-06, Vol.127 (6), p.e1482-e1489
• Main Authors: Burstein, Danielle S, Jacobs, Jeffrey P, Li, Jennifer S, Sheng, Shubin, O'Brien, Sean M, Rossi, Anthony F, Checchia, Paul A, Wernovsky, Gil, Welke, Karl F, Peterson, Eric D, Jacobs, Marshall L, Pasquali, Sara K
• Format: Article
• Language: English
• Subjects: Cardiac Surgical Procedures - utilization; Care and treatment; Childrens health; Company business management; Congenital heart defects; Congenital heart disease; Female; Heart Defects, Congenital - surgery; Heart surgery; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Length of Stay; Male; Management; Mortality; Outcome Assessment (Health Care); Patient outcomes; Pediatric intensive care units; Pediatrics; Risk assessment; Treatment Outcome
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2010-2796

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. 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. 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. 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 .