Texas Children's Hospital / Baylor College of Medicine, United States
Abstract: Introduction The purpose of these analyses was to determine how specific comorbidities and medical interventions impact risk of inpatient mortality in those with hypoplastic left heart syndrome undergoing Norwood procedure. The secondary aims were to determine the impact of these on billed charges, postoperative length of stay, and risk of cardiac arrest.
Methods Admissions from 2004 to 2015 in the Pediatric Health Information System database with hypoplastic left heart syndrome and Norwood procedure were identified. Admission characteristics, patient interventions, and the presence of comorbidities were captured and analyzed with ANOVA and a series of regression analyses.
Results A total of 5,138 admissions were identified meeting inclusion criteria. Of these 829 (16.1%) experienced inpatient mortality, and 352 (6.7%) experienced cardiac arrest. The frequency of inpatient mortality did not significantly change over the course of the study era. The frequency of cardiac arrest significantly decreased from 7.4% in 2004 to 4.3% in 2015 (p = 0.04). The frequency of pharmacologic therapies, particularly vasoactive use, decreased as the study period progressed.
Regression analyses demonstrated more recent year of surgery and use of calcium chloride, angiotensin converting enzyme inhibitor, and aspirin were associated with a significant decrease in both cardiac arrest and inpatient mortality. Arrythmias and use of vasopressin and continuous renal replacement therapy were associated with a significant increase in both cardiac arrest and inpatient mortality. Acute kidney injury, pulmonary hypertension, and use of norepinephrine, dopamine, peritoneal dialysis, and extracorporeal membrane oxygenation were only associated with an increase in inpatient mortality.
Similarly, regression analyses demonstrated a significant association between billed charges and postoperative length of stay with heart failure, presence of syndromes, arrythmias, acute kidney injury, and pulmonary hypertension.
Conclusions For patients with hypoplastic left heart syndrome undergoing the Norwood procedure, the frequency of most pharmacologic therapies included in this study, and cardiac arrest has decreased over time. There are significant associations between acute kidney injury, pulmonary hypertension, and arrythmias with inpatient mortality. Arrythmias also have a significant association with cardiac arrest. Notably, billed charges and postoperative length of stay have significant associations with heart failure, presence of syndromes, arrythmias, acute kidney injury, and pulmonary hypertension. These analyses characterize associations to provoke thought and help stimulate the development of hypotheses that can help guide future studies.
