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Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis

Published online by Cambridge University Press:  30 January 2019

Andrew M. Koth Open the ORCID record for Andrew M. Koth [Opens in a new window] ,
Claudia A. Algaze ,
Charlotte Sakarovitch ,
Jin Long ,
Komal Kamra ,
Gail E. Wright ,
Bambi Alexander-Banys ,
Katsuhide Maeda  and
Andrew Y. Shin
Andrew M. Koth*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Claudia A. Algaze
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Charlotte Sakarovitch
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Jin Long
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Komal Kamra
Affiliation:
Department of Anesthesia, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Gail E. Wright
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Bambi Alexander-Banys
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Katsuhide Maeda
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Andrew Y. Shin
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
*
Author for correspondence: Andrew Koth, Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA. E-mail: akoth@stanford.edu
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Abstract

Objective

This study sets out to determine the influence of age at the time of surgery as a risk factor for post-operative length of stay after bidirectional cavopulmonary anastomosis.

Methods

All patients undergoing a Glenn procedure between January 2010 and July 2015 were included in this retrospective cohort study. Demographic data were examined. Standard descriptive statistics was used. A univariable analysis was conducted using the appropriate test based on data distribution. A propensity score for balancing the group difference was included in the multi-variable analysis, which was then completed using predictors from the univariable analysis that achieved significance of p<0.1.

Results

Over the study period, 50 patients met the inclusion criteria. Patients were separated into two cohorts of ⩾4 months (28 patients) and <4 months (22 patients). Other than height and weight, the two cohorts were indistinguishable in their pre-operative saturation, medications, catheterisation haemodynamics, atrioventricular valve regurgitation, and ventricular function. After adjusting group differences, younger age was associated with longer post-operative length of hospitalisation – adjusted mean 15 (±2.53) versus 8 (±2.15) days (p=0.03). In a multi-variable regression analysis, in addition to ventricular dysfunction (β coefficient=8.8, p=0.05), Glenn procedures performed before 4 months were independently associated with longer length of stay (β coefficient=−6.9, p=0.03).

Conclusion

We found that Glenn procedures performed after 4 months of age had shorter post-operative length of stay when compared to a younger cohort. These findings suggest that balancing timing of surgery to decrease the inter-stage period should take into consideration differences in post-operative recovery with earlier operations.

Keywords

CHDhypoplastic left heart syndromeGlennbidirectional cavopulmonary anastomosislength of staycongenital cardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 369 - 374
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Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Koth AM, Algaze CA, Sakarovitch C, Long J, Kamra K, Wright GE, Alexander-Banys B, Maeda K, Shin AY. (2019) Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis. Cardiology in the Young29: 369–374. doi: 10.1017/S1047951118002470

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