TY - JOUR
T1 - Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial
AU - Schwartz, Steven M.
AU - Lu, Minmin
AU - Ohye, Richard G.
AU - Hill, Kevin D.
AU - Atz, Andrew M.
AU - Naim, Maryam Y.
AU - Williams, Ismee A.
AU - Goldberg, Caren S.
AU - Lewis, Alan
AU - Pigula, Frank
AU - Manning, Peter
AU - Pizarro, Christian
AU - Chai, Paul
AU - McCandless, Rachel
AU - Dunbar-Masterson, Carolyn
AU - Kaltman, Jonathan R.
AU - Kanter, Kirk
AU - Sleeper, Lynn A.
AU - Schonbeck, Julie V.
AU - Ghanayem, Nancy
N1 - Funding Information:
This study was supported by U01 grants from the National Heart, Lung, and Blood Institute ( HL068269 , HL068270 , HL068279 , HL068281 , HL068285 , HL068292 , HL068290 , HL068288 , HL085057 , HL109781 , and HL109737 ). This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health.
PY - 2014/6
Y1 - 2014/6
N2 - Background The single-ventricle reconstruction trial randomized patients with single right ventricle lesions to a modified Blalock-Taussig or right ventricle-to-pulmonary artery shunt at the Norwood. This analysis describes outcomes at the stage 2 procedure and factors associated with a longer hospital length of stay (LOS). Methods We examined the association of shunt type with stage 2 hospital outcomes. Cox regression and bootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associated with in-hospital death. Results There were 393 subjects in the analytic cohort. Median stage 2 procedure hospital LOS (8 days; interquartile range [IQR], 6-14 days), hospital mortality (4.3%), transplantation (0.8%), median ventilator time (2 days; IQR, 1-3 days), median intensive care unit LOS (4 days; IQR, 3-7 days), number of additional cardiac procedures or complications, and serious adverse events did not differ by shunt type. Longer LOS was associated (R2 = 0.26) with center, longer post-Norwood LOS (hazard ratio [HR], 1.93 per log day; P <.001), nonelective timing of the stage 2 procedure (HR, 1.78; P <.001), and pulmonary artery (PA) stenosis (HR, 1.56; P <.001). By univariate analysis, nonelective stage 2 (65% vs 32%; P =.009), moderate or greater atrioventricular valve (AVV) regurgitation (75% vs 24%; P <.001), and AVV repair (53% vs 9%; P <.001) were among the risk factors associated with in-hospital death. Conclusions Norwood LOS, PA stenoses, and nonelective stage 2 procedure, but not shunt type, are independently associated with longer LOS. Nonelective stage 2 procedure, moderate or greater AVV regurgitation, and need for AVV repair are among the risk factors for death.
AB - Background The single-ventricle reconstruction trial randomized patients with single right ventricle lesions to a modified Blalock-Taussig or right ventricle-to-pulmonary artery shunt at the Norwood. This analysis describes outcomes at the stage 2 procedure and factors associated with a longer hospital length of stay (LOS). Methods We examined the association of shunt type with stage 2 hospital outcomes. Cox regression and bootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associated with in-hospital death. Results There were 393 subjects in the analytic cohort. Median stage 2 procedure hospital LOS (8 days; interquartile range [IQR], 6-14 days), hospital mortality (4.3%), transplantation (0.8%), median ventilator time (2 days; IQR, 1-3 days), median intensive care unit LOS (4 days; IQR, 3-7 days), number of additional cardiac procedures or complications, and serious adverse events did not differ by shunt type. Longer LOS was associated (R2 = 0.26) with center, longer post-Norwood LOS (hazard ratio [HR], 1.93 per log day; P <.001), nonelective timing of the stage 2 procedure (HR, 1.78; P <.001), and pulmonary artery (PA) stenosis (HR, 1.56; P <.001). By univariate analysis, nonelective stage 2 (65% vs 32%; P =.009), moderate or greater atrioventricular valve (AVV) regurgitation (75% vs 24%; P <.001), and AVV repair (53% vs 9%; P <.001) were among the risk factors associated with in-hospital death. Conclusions Norwood LOS, PA stenoses, and nonelective stage 2 procedure, but not shunt type, are independently associated with longer LOS. Nonelective stage 2 procedure, moderate or greater AVV regurgitation, and need for AVV repair are among the risk factors for death.
UR - http://www.scopus.com/inward/record.url?scp=84901240635&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2013.07.063
DO - 10.1016/j.jtcvs.2013.07.063
M3 - Article
C2 - 24075564
AN - SCOPUS:84901240635
SN - 0022-5223
VL - 147
SP - 1791-1798.e4
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -