Author + information
- Joyce Johnson,
- Lloyd Tani,
- Tyler Bardsley,
- L. LuAnn Minich,
- Michael Puchalski,
- Jan Byrne and
- Nelangi Pinto
Prenatally diagnosed infants with congenital heart disease (CHD) who require surgery before discharge often have a delivery plan. We sought to determine the modifiable factors in perinatal management that impact postnatal resource utilization.
We reviewed infants with prenatally diagnosed CHD (born 8/05 to 12/11) requiring cardiac surgery before discharge. Exclusion criteria: <36 weeks, interventions before cardiac surgery, or transplant evaluation. Multivariate linear regression models were used to determine the impact of demographic and modifiable clinical factors on length of stay (LOS) and hospitalization cost.
Diagnoses (n=126) included single ventricle (60), coarctation (23), pulmonary atresia/stenosis (18), DTGA (11), TAPVR (3), IAA (3), and truncus arteriosus (8). Initial admission to the NICU vs CICU was independently associated with longer ICU LOS (30 vs 22d), total LOS (35 vs 27d), and more days intubated (16 vs 12) after adjusting for RACHS-1, birth weight, syndrome, PGE, delayed sternal closure, infections, and ECMO (Table). Hospital cost, intubation days, and LOS were not affected by day of delivery.
For infants with prenatally diagnosed CHD requiring surgery before discharge, initial admission to the NICU (vs. CICU) is associated with an increase in ICU LOS, total LOS, and days intubated. Prenatal planning for infants with CHD should consider initial place of admission as a modifiable factor to potentially lower resource utilization.
|Factor (multivariate analysis)||ICU LOS (days)||Hospital LOS (days)||Length of Intubation (days)||Hospital Cost ($)|
|NICU vs. CICU||+24% (p=0.03)||+19% (p<0.05)||+46% (p=0.002)||+7% (p=0.5)|
|Weekday vs weekend delivery||+10% (p=0.4)||+5% (p=0.6)||−11% (p=0.5)||−4% (p=0.7)|
|RACHS-1 (≥ 5 vs <5)||+11% (p=0.3)||+12% (p=0.2)||+33% (p=0.01)||+27% (p=0.009)|
|PGE dependence||+12% (p=0.4)||+10% (p=0.4)||+8% (p=0.7)||+3% (p=0.8)|
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Prenatal Diagnosis, Coronary Anomalies and More
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1162-130
- 2013 American College of Cardiology Foundation