Katherine E Bates1, Nicolas L Madsen2, Lara Khadr3, Zhiqian Gao2, Kari Crawford4, Michael Gaies3, Margaret Graupe2, Samuel P Hanke2, Anthony M Hlavacek5, Evonne Morell6, Sara K Pasquali3, Jennifer L Russell7, Susan K Schachtner8, Ronn E Tanel9, Adam L Ware10, Alaina K Kipps11. 1. Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: kebates@med.umich.edu. 2. The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio. 3. Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. 4. Pediatric Heart Surgery and Cardiology, Levine Children's Hospital, Charlotte, North Carolina. 5. Children's Heart Center, Medical University of South Carolina Children's Health, Charleston, South Carolina. 6. Heart Institute, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania. 7. Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada. 8. Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 9. Pediatric Heart Center, UCSF Benioff Children's Hospital, San Francisco, California; Department of Pediatrics, UCSF School of Medicine, San Francisco, California. 10. The Heart Center, Primary Children's Hospital, Salt Lake City, Utah. 11. Betty Irene Moore Children's Heart Center, Lucile Packard Childrens Hospital at Stanford, Palo Alto, California; Department of Pediatrics, Stanford School of Medicine, Palo Alto, California.
Abstract
BACKGROUND: Nearly every child undergoing congenital heart surgery has chest tubes placed intraoperatively. Center variation in removal practices and impact on outcomes has not been well described. This study evaluated variation in chest tube management practices and outcomes across centers. METHODS: The study included patients undergoing any of 10 benchmark operations from June 2017 to May 2018 at participating Pediatric Acute Care Cardiology Collaborative (PAC3) and Pediatric Cardiac Critical Care Consortium (PC4) centers. Clinical data from PC4 centers were merged with chest tube data from PAC3 centers. Practices and outcomes were compared across centers in univariate and multivariable analysis. RESULTS: The cohort included 1029 patients (N = 9 centers). Median chest tube duration varied significantly across centers for 9 of 10 benchmark operations (all P ≤ .03), with a "model" center noted to have the shortest duration for 9 of 10 operations (range, 27.9% to 87.4% shorter duration vs other centers across operations). This effect persisted in multivariable analysis (P < .0001). The model center had higher volumes of chest tube output before removal (median, 8.5 mL/kg/24 h [model] vs 2.2 mL/kg/24 h [other centers]; P < .001], but it did not have higher rates of chest tube reinsertion (model center 1.3% vs 2.1%; P = .59) or readmission for pleural effusion (model center 4.4% vs 3.0%; P = .31), and had the shortest length of stay for 7 of 10 operations. CONCLUSIONS: This study suggests significant center variation in chest tube removal practices and associated outcomes after congenital heart surgery. Best practices used at the model center have informed the design of an ongoing collaborative learning project aimed at reducing chest tube duration and length of stay.
BACKGROUND: Nearly every child undergoing congenital heart surgery has chest tubes placed intraoperatively. Center variation in removal practices and impact on outcomes has not been well described. This study evaluated variation in chest tube management practices and outcomes across centers. METHODS: The study included patients undergoing any of 10 benchmark operations from June 2017 to May 2018 at participating Pediatric Acute Care Cardiology Collaborative (PAC3) and Pediatric Cardiac Critical Care Consortium (PC4) centers. Clinical data from PC4 centers were merged with chest tube data from PAC3 centers. Practices and outcomes were compared across centers in univariate and multivariable analysis. RESULTS: The cohort included 1029 patients (N = 9 centers). Median chest tube duration varied significantly across centers for 9 of 10 benchmark operations (all P ≤ .03), with a "model" center noted to have the shortest duration for 9 of 10 operations (range, 27.9% to 87.4% shorter duration vs other centers across operations). This effect persisted in multivariable analysis (P < .0001). The model center had higher volumes of chest tube output before removal (median, 8.5 mL/kg/24 h [model] vs 2.2 mL/kg/24 h [other centers]; P < .001], but it did not have higher rates of chest tube reinsertion (model center 1.3% vs 2.1%; P = .59) or readmission for pleural effusion (model center 4.4% vs 3.0%; P = .31), and had the shortest length of stay for 7 of 10 operations. CONCLUSIONS: This study suggests significant center variation in chest tube removal practices and associated outcomes after congenital heart surgery. Best practices used at the model center have informed the design of an ongoing collaborative learning project aimed at reducing chest tube duration and length of stay.
Authors: Sara K Pasquali; Jennifer S Li; Xia He; Marshall L Jacobs; Sean M O'Brien; Matthew Hall; Robert D B Jaquiss; Karl F Welke; Eric D Peterson; Samir S Shah; J William Gaynor; Jeffrey P Jacobs Journal: Pediatrics Date: 2012-01-23 Impact factor: 7.124
Authors: Jeffrey Phillip Jacobs; Marshall Lewis Jacobs; Erle H Austin; Constantine Mavroudis; Sara K Pasquali; Francois G Lacour-Gayet; Christo I Tchervenkov; Hal Walters; Emile A Bacha; Pedro J Del Nido; Charles D Fraser; J William Gaynor; Jennifer C Hirsch; David L S Morales; Kamal K Pourmoghadam; James S Tweddell; Richard L Prager; John E Mayer Journal: World J Pediatr Congenit Heart Surg Date: 2012-01-01
Authors: Lindsay S Rogers; Andrew C Glatz; Chitra Ravishankar; Thomas L Spray; Susan C Nicolson; Jack Rychik; Christina Hayden Rush; J William Gaynor; David J Goldberg Journal: J Am Coll Cardiol Date: 2012-07-18 Impact factor: 24.094
Authors: Jeffrey Phillip Jacobs; Sean M O'Brien; Sara K Pasquali; Marshall Lewis Jacobs; Francois G Lacour-Gayet; Christo I Tchervenkov; Erle H Austin; Christian Pizarro; Kamal K Pourmoghadam; Frank G Scholl; Karl F Welke; Constantine Mavroudis Journal: Ann Thorac Surg Date: 2011-12 Impact factor: 4.330
Authors: Jeffrey Phillip Jacobs; Sean M O'Brien; Sara K Pasquali; Marshall Lewis Jacobs; François G Lacour-Gayet; Christo I Tchervenkov; Erle H Austin; Christian Pizarro; Kamal K Pourmoghadam; Frank G Scholl; Karl F Welke; J William Gaynor; David R Clarke; John E Mayer; Constantine Mavroudis Journal: Ann Thorac Surg Date: 2012-06-15 Impact factor: 4.330
Authors: Sara K Pasquali; Richard G Ohye; Minmin Lu; Jonathan Kaltman; Christopher A Caldarone; Christian Pizarro; Carolyn Dunbar-Masterson; J William Gaynor; Jeffrey P Jacobs; Aditya K Kaza; Jane Newburger; John F Rhodes; Mark Scheurer; Eric Silver; Lynn A Sleeper; Sarah Tabbutt; James Tweddell; Karen Uzark; Winfield Wells; William T Mahle; Gail D Pearson Journal: J Thorac Cardiovasc Surg Date: 2012-06-12 Impact factor: 5.209
Authors: Gil Wernovsky; Nancy Ghanayem; Richard G Ohye; Emile A Bacha; Jeffrey P Jacobs; J William Gaynor; Sarah Tabbutt Journal: Cardiol Young Date: 2007-09 Impact factor: 1.093
Authors: Jennifer C Hirsch; Caren Goldberg; Edward L Bove; Sepand Salehian; Timothy Lee; Richard G Ohye; Eric J Devaney Journal: Ann Surg Date: 2008-09 Impact factor: 12.969
Authors: Michael Gaies; David S Cooper; Sarah Tabbutt; Steven M Schwartz; Nancy Ghanayem; Nikhil K Chanani; John M Costello; Ravi R Thiagarajan; Peter C Laussen; Lara S Shekerdemian; Janet E Donohue; Gina M Willis; J William Gaynor; Jeffrey P Jacobs; Richard G Ohye; John R Charpie; Sara K Pasquali; Mark A Scheurer Journal: Cardiol Young Date: 2014-08-28 Impact factor: 1.093
Authors: Jason N Johnson; James Jaggers; Shuang Li; Sean M O'Brien; Jennifer S Li; Jeffrey P Jacobs; Marshall L Jacobs; Karl F Welke; Eric D Peterson; Sara K Pasquali Journal: J Thorac Cardiovasc Surg Date: 2010-02-18 Impact factor: 5.209
Authors: Alisa Arunamata; Theresa A Tacy; Saraswati Kache; Richard D Mainwaring; Michael Ma; Katsuhide Maeda; Rajesh Punn Journal: Ann Pediatr Cardiol Date: 2020-06-29
Authors: Ashraf S Harahsheh; Alaina K Kipps; Stephen A Hart; Steven C Cassidy; Martha L Clabby; Anthony M Hlavacek; Amanda K Hoerst; Margaret A Graupe; Nicolas L Madsen; Adnan M Bakar; Erica L Del Grippo; Sonali S Patel; James E Bost; Ronn E Tanel Journal: Pediatr Cardiol Date: 2021-04-04 Impact factor: 1.655
Authors: Katherine E Bates; Chloe Connelly; Lara Khadr; Margaret Graupe; Anthony M Hlavacek; Evonne Morell; Sara K Pasquali; Jennifer L Russell; Susan K Schachtner; Courtney Strohacker; Ronn E Tanel; Adam L Ware; Sharyl Wooton; Nicolas L Madsen; Alaina K Kipps Journal: J Am Heart Assoc Date: 2021-10-29 Impact factor: 5.501