Associations Between Day of Admission and Day of Surgery on Outcome and Resource Utilization in Infants With Hypoplastic Left Heart Syndrome Who Underwent Stage I Palliation (from the Single Ventricle Reconstruction Trial)

• Authors: Joyce T. Johnson, Ann & Robert H. Lurie Children’s Hospital of Chicago; Lynn A. Sleeper, New England Research Institutes; Shan Chen, New England Research Institutes; Richard G. Ohye, University of Michigan; Michael G. Gaies, University of Michigan; Ismee A. Williams, Columbia University; Ritu Sachdeva, Emory University; Jay D. Pruetz, Children’s Hospital Los Angeles; Gregory H. Tatum, Duke Children’s Hospital and Health Center; Deepika Thacker, Nemours/Alfred L. DuPont Hospital for Children; Marissa A. Brunetti, Childrens Hospital of Philadelphia; Michele A. Frommelt, Children’s Hospital Wisconsin; Jeffrey P. Jacobs, All Children’s Hospital; Joel A. Kirsh, The Hospital for Sick Children; Linda M. Lambert, University of Utah; Jane W. Newburger, Boston Children’s Hospital; Victoria L. Pemberton, National Heart, Lung and Blood Institute; Sinai C. Zyblewski, Medical University of South Carolina; Allison A. Divanovic, Cincinnati Children’s Hospital; Nelangi M. Pinto, University of Utah
• Journal Title: American Journal of Cardiology
• Volume: Volume 116, Number 8
• Publisher: Elsevier | 2015-10-15, Pages 1263-1269
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.amjcard.2015.07.044
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Health Sciences, General
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; NORWOOD PROCEDURE; MORTALITY; WEEKENDS; CHILDREN; WEEKDAY; STROKE; DISEASE

Abstract

Newborns with hypoplastic left heart syndrome and other single right ventricular variants require substantial health care resources. Weekend acute care has been associated with worse outcomes and increased resource use in other populations but has not been studied in patients with single ventricle. Subjects of the Single Ventricle Reconstruction trial were classified by whether they had a weekend admission and by day of the week of Norwood procedure. The primary outcome was hospital length of stay (LOS); secondary outcomes included transplant-free survival, intensive care unit (ICU) LOS, and days of mechanical ventilation. The Student's t test with log transformation and the Wilcoxon rank-sum test were used to analyze associations. Admission day was categorized for 533 of 549 subjects (13% weekend). The day of the Norwood was Thursday/Friday in 39%. There was no difference in median hospital LOS, transplant-free survival, ICU LOS, or days ventilated for weekend versus non-weekend admissions. Day of the Norwood procedure was not associated with a difference in hospital LOS, transplant-free survival, ICU LOS, or days ventilated. Prenatally diagnosed infants born on the weekend had lower mean birth weight, younger gestational age, and were more likely to be intubated but did not have a difference in measured outcomes. In conclusion, in this cohort of patients with single right ventricle, neither weekend admission nor end-of-the-week Norwood procedure was associated with increased use of hospital resources or poorer outcomes. We speculate that the complex postoperative course following the Norwood procedure outweighs any impact that day of admission or operation may have on these outcomes.