Abstract 13639: Time to Extubation May Indicate Quality of Care Following Neonatal Cardiac Surgery
Background: Most neonates survive cardiac surgery, but assessing quality of care is challenging. We aimed to determine: a) minimum time to extubation (TTE) assuming “perfect” care (i.e. no complications and adequate repair) and b) how potentially avoidable events influence TTE.
Methods: Neonates <30 days old undergoing RACHS-1 classifiable surgery from 1/09-1/13 were reviewed using existing data. Technical performance score (TPS) measures adequacy of repair using imaging and clinical criteria prior to hospital discharge: class 1 (trivial/no residua), class 2(minor residua) and class 3 (major residua/re-intervention). Minimum TTE was determined for RACHS-1 class 2, 3-4 and 5-6. Classes 3 and 4 were collapsed as TTE was similar and 5-6 due to too few class 5 pts. Multiple linear regression was used to identify the variables associated with TTE days.
Results: 601 neonates underwent surgery, 58% were male, median age (IQR) was 5.6 (3.6, 9.4) days, median (IQR) BSA was 0.21 (0.19, 0.22) m2; 27% had single ventricle palliation. STS defined-preop factors occurred in 35% (e.g. preop ventilation, genetic anomalies, shock, need for CPR, and sepsis) while postop complications in 72%. 95% of patients with class 3 TPS and 67% of pts with class 1-2 TPS had postoperative complications (p<0.001). Preop (p=0.015) and postop (p<0.001) complications, RACHS-1 class (p<0.001) and class 3 TPS (p<0.001) were associated with increased TTE. Table 1 indicates that with class 3 TPS, preop factors and postop complications, TTE increases across each RACHS-1 class, with the lowest TTE occurring in patients with an class 1 or 2 TPS and no preop factors or postop complications.
Conclusion: Class 3 (major residua/re-intervention) surgical performance, preop factors and postop complications affect TTE. Recognizing that not all postop complications are avoidable, TTE may be a surrogate measurement of the quality of care.
Author Disclosures: J. Blinder: None. R. Thiagarajan: None. K. Williams: None. M. Nathan: None. J. Mayer: None. T. Kulik: None.
- © 2015 by American Heart Association, Inc.