Aaron Eckhauser1, Sara K Pasquali2, Chitra Ravishankar3, Linda M Lambert1, Jane W Newburger4, Andrew M Atz5, Nancy Ghanayem6, Steven M Schwartz7, Chong Zhang8, Jeffery P Jacobs9, L LuAnn Minich1. 1. 1Department of Surgery,Division of Cardiothoracic Surgery,Section of Pediatric Cardiothoracic Surgery,University of Utah,Primary Children's Hospital,Salt Lake City,UT,USA. 2. 2Department of Pediatrics,Division of Pediatric Cardiology,University of Michigan,C.S. Mott Children's Hospital,Ann Arbor,MI,USA. 3. 3Department of Pediatrics,Division of Pediatric Cardiology,Children's Hospital of Philadelphia,Philadelphia,PA,USA. 4. 4Department of Cardiology,Boston Children's Hospital,Boston,MA,USA. 5. 6Department of Pediatrics,Division of Cardiology,Medical University of South Carolina,Charleston,SC,USA. 6. 7Department of Pediatrics,Division of Pediatric Critical Care,Baylor College of Medicine,Texas Children's Hospital,Houston,TX,USA. 7. 8Departments of Critical Care Medicine and Paediatrics,Divisions of Cardiac Critical Care Medicine and Cardiology,University of Toronto,The Hospital for Sick Children,Toronto,CA,USA. 8. 9Division of Epidemiology,University of Utah,Salt Lake City,UT,USA. 9. 10Department of Surgery,Division of Cardiovascular Surgery,John's Hopkins University,Johns Hopkins All Children's Hospital,St. Petersburg,FL,USA.
Abstract
BACKGROUND: The Single Ventricle Reconstruction trial randomised neonates with hypoplastic left heart syndrome to a systemic-to-pulmonary-artery shunt strategy. Patients received care according to usual institutional practice. We analysed practice variation at the Stage II surgery to attempt to identify areas for decreased variation and process control improvement. METHODS: Prospectively collected data were available in the Single Ventricle Reconstruction public-use database. Practice variation across 14 centres was described for 397 patients who underwent Stage II surgery. Data are centre-level specific and reported as interquartile ranges across all centres, unless otherwise specified. RESULTS: Preoperative Stage II median age and weight across centres were 5.4 months (interquartile range 4.9-5.7) and 5.7 kg (5.5-6.1), with 70% performed electively. Most patients had pre-Stage-II cardiac catheterisation (98.5-100%). Digoxin was used by 11/14 centres in 25% of patients (23-31%), and 81% had some oral feeds (68-84%). The majority of the centres (86%) performed a bidirectional Glenn versus hemi-Fontan. Median cardiopulmonary bypass time was 96 minutes (75-113). In aggregate, 26% of patients had deep hypothermic circulatory arrest >10 minutes. In 13/14 centres using deep hypothermic circulatory arrest, 12.5% of patients exceeded 10 minutes (8-32%). Seven centres extubated 5% of patients (2-40) in the operating room. Postoperatively, ICU length of stay was 4.8 days (4.0-5.3) and total length of stay was 7.5 days (6-10). CONCLUSIONS: In the Single Ventricle Reconstruction Trial, practice varied widely among centres for nearly all perioperative factors surrounding Stage II. Further analysis may facilitate establishing best practices by identifying the impact of practice variation.
RCT Entities:
BACKGROUND: The Single Ventricle Reconstruction trial randomised neonates with hypoplastic left heart syndrome to a systemic-to-pulmonary-artery shunt strategy. Patients received care according to usual institutional practice. We analysed practice variation at the Stage II surgery to attempt to identify areas for decreased variation and process control improvement. METHODS: Prospectively collected data were available in the Single Ventricle Reconstruction public-use database. Practice variation across 14 centres was described for 397 patients who underwent Stage II surgery. Data are centre-level specific and reported as interquartile ranges across all centres, unless otherwise specified. RESULTS: Preoperative Stage II median age and weight across centres were 5.4 months (interquartile range 4.9-5.7) and 5.7 kg (5.5-6.1), with 70% performed electively. Most patients had pre-Stage-II cardiac catheterisation (98.5-100%). Digoxin was used by 11/14 centres in 25% of patients (23-31%), and 81% had some oral feeds (68-84%). The majority of the centres (86%) performed a bidirectional Glenn versus hemi-Fontan. Median cardiopulmonary bypass time was 96 minutes (75-113). In aggregate, 26% of patients had deep hypothermic circulatory arrest >10 minutes. In 13/14 centres using deep hypothermic circulatory arrest, 12.5% of patients exceeded 10 minutes (8-32%). Seven centres extubated 5% of patients (2-40) in the operating room. Postoperatively, ICU length of stay was 4.8 days (4.0-5.3) and total length of stay was 7.5 days (6-10). CONCLUSIONS: In the Single Ventricle Reconstruction Trial, practice varied widely among centres for nearly all perioperative factors surrounding Stage II. Further analysis may facilitate establishing best practices by identifying the impact of practice variation.
Entities:
Keywords:
Classifications; Fontan; hypoplastic left heart syndrome; management; perioperative care; quality care
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