William T Mahle1, Jeffrey P Jacobs2, Marshall L Jacobs3, Sunghee Kim4, Paul M Kirshbom5, Sara K Pasquali6, Erle H Austin7, Kirk R Kanter8, Susan C Nicolson9, Kevin D Hill4. 1. Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia. Electronic address: wmahle@emory.edu. 2. All Children's Hospital and Johns Hopkins University, St. Petersburg, Florida. 3. Johns Hopkins Heart and Vascular Institute, Baltimore, Maryland. 4. Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. 5. Yale University, New Haven, Connecticut. 6. University of Michigan, Ann Arbor, MI. 7. Kosair Children's Hospital, Louisville, Kentucky. 8. Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia. 9. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. METHODS: Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. RESULTS: Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early extubation after TOF repair was associated with heavier weight at operation (p < 0.001) and fewer preoperative risk factors (p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate (p = 0.04). No association was found between center early extubation rate and PLOS for Fontan procedures (p = 0.08). CONCLUSIONS: Early extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
BACKGROUND: There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. METHODS: Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. RESULTS: Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early extubation after TOF repair was associated with heavier weight at operation (p < 0.001) and fewer preoperative risk factors (p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate (p = 0.04). No association was found between center early extubation rate and PLOS for Fontan procedures (p = 0.08). CONCLUSIONS: Early extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
Authors: Michael Gaies; David K Werho; Wenying Zhang; Janet E Donohue; Sarah Tabbutt; Nancy S Ghanayem; Mark A Scheurer; John M Costello; J William Gaynor; Sara K Pasquali; Justin B Dimick; Mousumi Banerjee; Steven M Schwartz Journal: Ann Thorac Surg Date: 2017-10-05 Impact factor: 4.330
Authors: William T Mahle; Susan C Nicolson; Danielle Hollenbeck-Pringle; Michael G Gaies; Madolin K Witte; Eva K Lee; Michelle Goldsworthy; Paul C Stark; Kristin M Burns; Mark A Scheurer; David S Cooper; Ravi Thiagarajan; V Ben Sivarajan; Steven D Colan; Marcus S Schamberger; Lara S Shekerdemian Journal: Pediatr Crit Care Med Date: 2016-10 Impact factor: 3.624
Authors: Torsten Baehner; Philipp Pruemm; Mathieu Vergnat; Boulos Asfour; Nadine Straßberger-Nerschbach; Andrea Kirfel; Michael Hamann; Andreas Mayr; Ehrenfried Schindler; Markus Velten; Maria Wittmann Journal: J Clin Med Date: 2022-09-01 Impact factor: 4.964
Authors: Christopher F Tirotta; Stephen Alcos; Richard G Lagueruela; Daria Salyakina; Weize Wang; Jessica Hughes; Marysory Irizarry; Redmond P Burke Journal: J Cardiothorac Surg Date: 2020-01-06 Impact factor: 1.637