Abstract 16899: Interstage Care at the Primary Surgical Center is Associated With More Detection of Feeding and Breathing Problems, Readmissions and Emergency Department Visits
Objective: Morbidity and mortality remain high for patients with hypoplastic left heart syndrome during the interstage period between Norwood and bidirectional Glenn despite ongoing QI efforts. We sought to identify associations between the site of interstage care and red flag events, emergency department visits, readmissions, and mortality.
Methods: Data for patients enrolled in the NPC-QIC database from July 2008 through February 2013 were retrospectively reviewed. Patients had outpatient interstage care at (1) the surgical site (SS) performing Norwood, (2) a non-surgical site (NSS), or (3) a combination. The distance of any NSS from its respective SS was calculated. Interstage feeding and breathing problems, readmissions, and deaths were compared among SS, NSS and combination patients. Among patients followed at a NSS, deaths were compared by distance from SS.
Results: There were 675 patients from 47 sites who met entry criteria. Patients were followed at the SS 411 (61%), NSS 121 (18%), or a combination 143 (21%). There were 66 deaths (10%) among the entire cohort: 37 (9%) at SS, 13 (11%) at NSS, 15 (10%) at combination, and 1 with data missing. The proportion of deaths among the 3 groups was not statistically significant (p=0.60), nor was there a difference based on distance from SS. However, patients followed at the SS were more likely to have problems detected with feeding (p=0.04) and breathing (p=0.02), ED visits (p<0.001), and readmissions (p=0.003).
Conclusions: The site of interstage care was not associated with mortality. Among patients followed at NSS during the interstage, distance from the SS was not associated with mortality. Patients followed at the primary (surgical) center had more detected breathing and feeding problems, ED visits, and readmissions. This may represent increased vigilance, care access or data collection. Further study is required to elucidate the clinical significance of these differences.
- © 2013 by American Heart Association, Inc.