Abstract 9384: The Impact of Intensive Care Unit Structure on Post-operative Outcomes Following Congenital Heart Surgery: Analysis of a Multi-institutional Database
Background: Recently there has been a shift toward care of congenital cardiac pts in dedicated pediatric cardiac intensive care units (CICU). The impact of this trend on pt outcomes is unclear. We evaluated outcomes associated with a CICU vs. other ICU models.
Methods: Society of Thoracic Surgeons Congenital Heart Surgery Database participants (2007–2009) who completed an ICU survey were included. In multivariable analysis accounting for within center clustering, we evaluated outcomes [in-hospital mortality, length of stay (LOS), and complications] associated with a CICU (freestanding unit dedicated to pediatric cardiac pts) vs. other ICU, adjusting for center volume and patient factors [age, weight, non-cardiac abnormality, other pre-op risk factors, and Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) risk group (categories 1–5)].
Results: A total of 20,922 pts (47 centers, 25 CICU) were included: median age 6.6m [interquartile range (IQR) 34d – 3.9y]. The 2 ICU groups were similar regarding pt age, weight, and previous cardiac surgery. The CICU group included higher volume centers and slightly more high risk procedures. Pts in the other ICU group had more non-cardiac abnormalities and other pre-op risk factors. Unadjusted mortality in the overall cohort was 3.8%, median LOS was 6d (IQR 4–13), and 21% had ≥ 1 complication. In multivariable analysis adjusting for patient and center factors, there was no difference in mortality comparing CICU vs. other ICU (OR 0.9, 95% CI 0.7 – 1.4, p=0.4). In stratified analysis by STS-EACTS category, CICU was associated with lower mortality in STS-EACTS category 3 (OR 0.5, 95% CI 0.3 – 0.9, p=0.01), primarily related to atrioventricular canal repair and arterial switch operation. There was no difference in LOS (0.05 log days, standard error 0.05, p=0.4) or complications (OR 1.1, 95% CI 0.7–1.7, p=0.6) overall or in stratified analyses.
Conclusions: These data suggest improved survival for certain pts cared for in a dedicated CICU, but no survival benefit overall and no difference in LOS or complications. Further investigation focusing not only on ICU structure, but differences in personnel and care processes may elucidate other factors impacting outcome in this population.
- © 2010 by American Heart Association, Inc.