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Emergency department utilisation and critical readmission in patients with Fontan circulation

Published online by Cambridge University Press:  30 October 2020

Katherine Cashen Open the ORCID record for Katherine Cashen [Opens in a new window] ,
Tara L. Petersen ,
Cailyn Rood ,
Daniel Cater ,
Sheila F. Waslawski ,
James E. Slaven  and
Christopher W. Mastropietro Open the ORCID record for Christopher W. Mastropietro [Opens in a new window]
Katherine Cashen*
Affiliation:
Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI, USA
Tara L. Petersen
Affiliation:
Division of Critical Care, Department of Pediatrics, The Children’s Hospital of Wisconsin/The Medical College of Wisconsin, Milwaukee, WI, USA
Cailyn Rood
Affiliation:
Division of Critical Care, Department of Pediatrics, The Children’s Hospital of Wisconsin/The Medical College of Wisconsin, Milwaukee, WI, USA
Daniel Cater
Affiliation:
Division of Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health/Indiana University School of Medicine, Indianapolis, IN, USA
Sheila F. Waslawski
Affiliation:
Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI, USA
James E. Slaven
Affiliation:
Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
Christopher W. Mastropietro
Affiliation:
Division of Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health/Indiana University School of Medicine, Indianapolis, IN, USA
*
Author for correspondence: Katherine Cashen, DO, Children’s Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA. Tel: +1 (313) 745 5629; Fax +1 (313) 966 0105. E-mail: kcashen@med.wayneedu
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Abstract

Background:

We aimed to conduct a multi-centre study characterising emergency department utilisation and critical readmissions experienced by children with Fontan circulation.

Methods:

We conducted a retrospective review of children who underwent the Fontan operation at three institutions (i.e., centres A, B, and C) between 2009 and 2014, with follow-up through December 2015. Multi-variable analyses were performed to determine factors associated for emergency department utilisation within 1 year of surgery, emergency department utilisation at any time following surgery, or critical readmission (defined as admission to ICU, operating room, or cardiac catheterisation).

Results:

We reviewed 297 patients, of which 147 patients (49%) had 607 emergency department encounters. Forty-six patients (15%) required 71 critical readmissions. Multi-variable analyses revealed centre C (p = 0.02) and post-operative hospitalisation ≥ 14 days (p = 0.03) to be significantly associated with emergency department utilisation within 1 year, whereas centre B (p < 0.001), post-operative hospitalisation ≥ 14 days (p = 0.002), and African-American/Black race (p = 0.04) were significantly associated with critical readmission.

Conclusions:

In this multi-centre study, nearly half of patients with Fontan circulation received emergency department care, often presenting with high disease acuity requiring readmission. Emergency department utilisation and need for critical readmission were independently influenced by the centre at which surgery was performed, prolonged post-operative hospitalisation, and racial background. These data could help guide quality improvement efforts aimed at reducing morbidity in this unique patient population.

Keywords

Emergency departmentsFontan procedureCHDpatient readmission
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1902 - 1909
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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