O0010: Standardizing Discharge Furosemide Duration Following Uncomplicated Congenital Heart Surgery: A Pediatric Acute Care Cardiology Collaborative (PAC3) QI Initiative

Purpose/Objectives: Children undergoing congenital heart surgery are routinely prescribed furosemide at hospital discharge. No clinical guidelines exist regarding the appropriate duration of furosemide following uncomplicated congenital heart surgery. Furosemide has known adverse effects including electrolyte imbalances, bone loss and fractures, ototoxicity, dehydration, and renal failure. Our aim was to implement a standardized early diuretic wean protocol to decrease the cumulative duration of furosemide exposure in children following congenital heart surgery.

Design/Methods: The early diuretic wean protocol consisted of a maximum dose of furosemide 1mg/kg/dose once or twice daily for 5 days after discharge with post-operative follow-up at 2 weeks. Patients undergoing 10 common congenital heart surgeries were included. Exclusion criteria included: neonates (though isolated coarctation repair was included), single ventricle physiology, post-operative chylous effusions, ≥ moderate residual shunts, ≥ moderate valvar insufficiency or stenosis, persistent post-operative pericardial or pleural effusions, and ≥ moderate systolic or diastolic dysfunction. Balancing measures included 30-day hospital readmission, new or worsening pleural effusion at follow up, and the need to restart furosemide at follow-up. After successful implementation at a single center, the project was expanded to include 3 total centers using the Pediatric Acute Care Cardiology Collaborative (PAC3).

Results: 221 patients (73 pre-intervention and 148 post-intervention) from 3 centers were included. Following protocol initiation, the mean duration of furosemide usage decreased from 19.2 days to 6.9 days, 12.5 days to 4.1 days, 13.1 to 8.6 days in the three centers. Protocol adherence ranged from 68% to 83%. The overall cohort demonstrated a decrease in furosemide usage from a mean of 15.1 to 7 days (Figure 1). There was no significant change in the rate of new or worsening pleural effusion or re-initiation of furosemide at follow-up in the pre- and post-intervention groups. There were no readmissions in the pre-intervention group and one in the post-intervention group.

Conclusion/Discussion: We were able to safely decrease the duration of furosemide exposure in children following discharge from uncomplicated congenital heart surgery without adverse effects. Additionally, we demonstrate the ability to expand from a single center to a multi-site QI project within PAC3.