@Article{chd.12649,
AUTHOR = {Janet M. Simsic, Christina Phelps, Kristin Kirchner, Kirby‐Rose Carpenito, Robin Allen, Holly Miller‐Tate, Karen Texter, Mark Galantowicz},
TITLE = {Interstage outcomes in single ventricle patients undergoing hybrid stage 1 palliation},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {5},
PAGES = {757--763},
URL = {http://www.techscience.com/schd/v13n5/39056},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Interstage readmissions are common in infants with single ventricle congenital
heart disease undergoing staged surgical palliation. We retrospectively examined readmissions
during the interstage period.<br/>
<b>Design:</b> Retrospective analysis.<br/>
<b>Setting:</b> The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio.<br/>
<b>Patients:</b> Newborns undergoing hybrid stage 1 palliation from January 2012 to December 2016
who survived to hospital discharge and were followed at our institution.<br/>
<b>Interventions: </b>All patients underwent hybrid stage 1 palliation.<br/>
<b>Outcome Measures:</b> Outcomes included (1) reason for interstage readmission; (2) feeding modality during interstage period; (3) major interstage adverse events; and (4) interstage
mortality.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusion:</b> 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.},
DOI = {10.1111/chd.12649}
}