Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

Eric A. Johnson, M. Mujeeb Zubair, Laurie Armsby, Grant Burch, Milon K. Good, Michael R. Lasarev, Alan (Roger) Hohimer, Ashok Muralidaran, Stephen M. Langley

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p <0.001), and unplanned postoperative cardiac catheterization (p <0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1–2.2, p = 0.014), 1.7 (95 % CI 1.2–2.3, p = 0.001), 1.8 (95 % CI 1.4–2.3, p <0.001), and 2.0 (95 % CI 1.7–2.4, p <0.001) times as long, respectively. These effects equated to an additional 4.5–7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalPediatric Cardiology
DOIs
StateAccepted/In press - Jan 7 2016

Fingerprint

Heart Diseases
Length of Stay
Heart Block
Cardiac Catheterization
Diaphragm
Paralysis
Risk Adjustment
Mediastinitis
Vocal Cord Paralysis
Quality Improvement
Thoracic Surgery
Hemorrhage
Mortality
Incidence
Population

Keywords

  • Congenital heart
  • Length of stay
  • Metrics
  • Quality improvement
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease. / Johnson, Eric A.; Zubair, M. Mujeeb; Armsby, Laurie; Burch, Grant; Good, Milon K.; Lasarev, Michael R.; Hohimer, Alan (Roger); Muralidaran, Ashok; Langley, Stephen M.

In: Pediatric Cardiology, 07.01.2016, p. 1-8.

Research output: Contribution to journalArticle

Johnson, Eric A. ; Zubair, M. Mujeeb ; Armsby, Laurie ; Burch, Grant ; Good, Milon K. ; Lasarev, Michael R. ; Hohimer, Alan (Roger) ; Muralidaran, Ashok ; Langley, Stephen M. / Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease. In: Pediatric Cardiology. 2016 ; pp. 1-8.
@article{78cea78062d84c67a68fac049a855c4f,
title = "Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease",
abstract = "Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p <0.001), and unplanned postoperative cardiac catheterization (p <0.001). Compared with patients without each metric, LOS was 1.6 (95 {\%} CI 1.1–2.2, p = 0.014), 1.7 (95 {\%} CI 1.2–2.3, p = 0.001), 1.8 (95 {\%} CI 1.4–2.3, p <0.001), and 2.0 (95 {\%} CI 1.7–2.4, p <0.001) times as long, respectively. These effects equated to an additional 4.5–7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.",
keywords = "Congenital heart, Length of stay, Metrics, Quality improvement, Surgery",
author = "Johnson, {Eric A.} and Zubair, {M. Mujeeb} and Laurie Armsby and Grant Burch and Good, {Milon K.} and Lasarev, {Michael R.} and Hohimer, {Alan (Roger)} and Ashok Muralidaran and Langley, {Stephen M.}",
year = "2016",
month = "1",
day = "7",
doi = "10.1007/s00246-015-1319-x",
language = "English (US)",
pages = "1--8",
journal = "Pediatric Cardiology",
issn = "0172-0643",
publisher = "Springer New York",

}

TY - JOUR

T1 - Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

AU - Johnson, Eric A.

AU - Zubair, M. Mujeeb

AU - Armsby, Laurie

AU - Burch, Grant

AU - Good, Milon K.

AU - Lasarev, Michael R.

AU - Hohimer, Alan (Roger)

AU - Muralidaran, Ashok

AU - Langley, Stephen M.

PY - 2016/1/7

Y1 - 2016/1/7

N2 - Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p <0.001), and unplanned postoperative cardiac catheterization (p <0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1–2.2, p = 0.014), 1.7 (95 % CI 1.2–2.3, p = 0.001), 1.8 (95 % CI 1.4–2.3, p <0.001), and 2.0 (95 % CI 1.7–2.4, p <0.001) times as long, respectively. These effects equated to an additional 4.5–7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.

AB - Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p <0.001), and unplanned postoperative cardiac catheterization (p <0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1–2.2, p = 0.014), 1.7 (95 % CI 1.2–2.3, p = 0.001), 1.8 (95 % CI 1.4–2.3, p <0.001), and 2.0 (95 % CI 1.7–2.4, p <0.001) times as long, respectively. These effects equated to an additional 4.5–7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.

KW - Congenital heart

KW - Length of stay

KW - Metrics

KW - Quality improvement

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84953206013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953206013&partnerID=8YFLogxK

U2 - 10.1007/s00246-015-1319-x

DO - 10.1007/s00246-015-1319-x

M3 - Article

SP - 1

EP - 8

JO - Pediatric Cardiology

JF - Pediatric Cardiology

SN - 0172-0643

ER -