Risk factors for prolonged length of stay after the stage 2 procedure in聽the single-ventricle reconstruction trial

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• 作者：Steven M. Schwartz ; MD^a ; ^{steven.schwartz@sickkids.ca" class="auth_mail} ; Minmin Lu ; MS^b ; Richard G. Ohye ; MD^c ; Kevin D. Hill ; MD^d ; Andrew M. Atz ; MD^e ; Maryam Y. Naim ; MD^f ; Ismee A. Williams ; MD ; MS^g ; Caren S. Goldberg ; MD ; MS^h ; Alan Lewis ; MDⁱ ; Frank Pigula ; MD^j ; Peter Manning ; MD^k ; Christian Pizarro ; MD^l ; Paul Chai ; MD^m ; Rachel McCandless ; MDⁿ ; Carolyn Dunbar-Masterson ; BSN^o ; Jonathan R. Kaltman ; MD^p ; Kirk Kanter ; MD^q ; Lynn A. Sleeper ; ScD^b ; Julie V. Schonbeck ; MSN ; C-PNP^b ; Nancy Ghanayem ; MD^r ; for the Pediatric Heart Network Investigators
• 关键词：20 ; 21
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：June 2014
• 年：2014
• 卷：147
• 期：6
• 页码：1791-1798.e4
• 全文大小：324 K

文摘

The single-ventricle reconstruction trial randomized patients with single right ventricle lesions to a modified Blalock-Taussig or right ventricle-to-pulmonary artery shunt at the Norwood. This analysis describes outcomes at the stage 2 procedure and factors associated with a longer hospital length of stay (LOS).

absSec_2">Methods

abspara0015">We examined the association of shunt type with stage 2 hospital outcomes. Cox regression and bootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associated with in-hospital death.

absSec_3">Results

abspara0020">There were 393 subjects in the analytic cohort. Median stage 2 procedure hospital LOS (8 days; interquartile range [IQR], 6-14 days), hospital mortality (4.3%), transplantation (0.8%), median ventilator time (2 days; IQR, 1-3 days), median intensive care unit LOS (4 days; IQR, 3-7 days), number of additional cardiac procedures or complications, and serious adverse events did not differ by shunt type. Longer LOS was associated (R² = 0.26) with center, longer post-Norwood LOS (hazard ratio [HR], 1.93 per log day; P < .001), nonelective timing of the stage 2 procedure (HR, 1.78; P < .001), and pulmonary artery (PA) stenosis (HR, 1.56; P < .001). By univariate analysis, nonelective stage 2 (65% vs 32%; P = .009), moderate or greater atrioventricular valve (AVV) regurgitation (75% vs 24%; P < .001), and AVV repair (53% vs 9%; P < .001) were among the risk factors associated with in-hospital death.

absSec_4">Conclusions

abspara0025">Norwood LOS, PA stenoses, and nonelective stage 2 procedure, but not shunt type, are independently associated with longer LOS. Nonelective stage 2 procedure, moderate or greater AVV regurgitation, and need for AVV repair are among the risk factors for death.