TY - EJOU
AU - Simsic, Janet M.
AU - Phelps, Christina
AU - Kirchner, Kristin
AU - Carpenito, Kirby‐Rose
AU - Allen, Robin
AU - Miller‐Tate, Holly
AU - Texter, Karen
AU - Galantowicz, Mark
TI - Interstage outcomes in single ventricle patients undergoing hybrid stage 1 palliation
T2 - Congenital Heart Disease
PY - 2018
VL - 13
IS - 5
SN - 1747-0803
AB - Objective: Interstage readmissions are common in infants with single ventricle congenital
heart disease undergoing staged surgical palliation. We retrospectively examined readmissions
during the interstage period.
Design: Retrospective analysis.
Setting: The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio.
Patients: Newborns undergoing hybrid stage 1 palliation from January 2012 to December 2016
who survived to hospital discharge and were followed at our institution.
Interventions: All patients underwent hybrid stage 1 palliation.
Outcome Measures: Outcomes included (1) reason for interstage readmission; (2) feeding modality during interstage period; (3) major interstage adverse events; and (4) interstage
mortality.
Results: Study group comprised 57 patients. Five patients only admitted once during the interstage period for scheduled cardiac catheterization were included in the no readmission
group. Therefore, 43 patients (75%) had a total of 87 interstage readmissions. Fourteen patients had 15 major interstage adverse events accounting for 17% of total readmissions.
Stroke (n = 1); sepsis (n = 1); pericardial effusion requiring drainage (n = 1); mesenteric ischemia (n = 1); shock (n = 1); and cardiac catheterization requiring intervention (n = 11)—
ductal stent balloon angioplasty (n = 3), enlargement of atrial septal defect/stent placement
(n = 3), retrograde aortic arch stenosis (n = 4). Thirty‐three readmissions were secondary to
gastrointestinal/feeding issues; 15 cyanosis; 15 work of breathing; and 9 asymptomatic patients. Four patients suffered interstage deaths (7%). Five patients (9%) spent >30 days in the
hospital during the interstage period. Of the 47 newborns (82%) discharged exclusively orally
feeding, 74% remained all orally feeding throughout interstage period. No patient discharged
with tube feedings learned to eat during the interstage period.
Conclusion: Interstage readmissions are common in the hybrid patient population. Seventeen
percent were secondary to major adverse events. Interstage mortality was 7%. Future studies
to identify interventions aimed at decreasing feeding issues and viral bronchiolitis in this tenuous patient population will hopefully improve quality outcomes, reduce readmissions, and
lessen health care costs.
KW - feeding
KW - hybrid palliation
KW - interstage
KW - outcomes
KW - readmissions
KW - single ventricle
DO - 10.1111/chd.12649