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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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References

Cashen, K, Gupta, P, Lieh-Lai, M, Mastropietro, CW. Infants with single ventricle physiology in the emergency department: are physicians prepared? J Pediatr. 2011; 159: 273–277.CrossRefGoogle ScholarPubMed
Hehir, DA, Dominquez, TE, Ballweg, JA, et al. Risk factors for interstage death after stage I reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg. 2008; 136: 94–99.CrossRefGoogle Scholar
Ohye, RG, Schonbeck, JV, Eghtesady, P, et al. Cause, timing, and location of death in the Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg. 2012; 144: 907–914.CrossRefGoogle ScholarPubMed
Ghanayem, NS, Allen, KR, Tabbut, S, et al. Interstage mortality after the Norwood procedure: results of the multi-center Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg. 2012; 144: 896–906.CrossRefGoogle Scholar
Prentice, E, Morey, N, Richards, K, Mastropietro, CW. Emergency department use after stage II palliation for children with single ventricle lesions. Pediatr Emerg Care. 2015; 31: 343–347.CrossRefGoogle ScholarPubMed
Crowe, S, Ridout, DA, Knowles, R, et al. Death and emergency readmission of infants discharged after interventions for congenital heart disease: a national study of 7643 infants to inform service improvement. J Am Heart Assoc. 2016; 5: e03369.CrossRefGoogle ScholarPubMed
Yabrodi, M, Mastropietro, CW. Hypoplastic left heart syndrome: from comfort care to long-term survival. Pediatr Res. 2017; 81: 142–149.CrossRefGoogle ScholarPubMed
Savitsky, E, Alejos, J, Votey, S. Emergency department presentations of congenital heart disease. J Emerg Med. 2003; 24: 239–245.CrossRefGoogle ScholarPubMed
Lee, YS, Baek, JS, Kwon, BS, et al. Pediatric emergency room presentation of congenital heart disease. Korean Circ J. 2010; 40 36–40.CrossRefGoogle ScholarPubMed
McDermott, KW, Stocks, C, Freeman, WJ. Overview of Pediatric Emergency Department Visits. 2015: Statistical Brief #242. August 2018. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville, MD. Agency for Healthcare Research and Quality; available from: https://www.ncbi.Nlm.nih.gov/books/NBK526418/ Google Scholar
Ephrem, G, Hebson, C, John, A, et al. Frontiers in Fontan failure: innovation and improving outcomes: a conference summary. Congenit Heart Dis. 2018; 1–10.Google Scholar
Cross, KP, Santucci, KA. Transitional medicine: will emergency medicine physicians be ready for the growing population of adults with congenital heart disease? Pediatr Emerg Care. 2006; 22: 775–781.CrossRefGoogle ScholarPubMed
Gonzalez, PC, Gauvreau, K, Demone, JA, et al. Regional racial and ethnic differences in mortality for congenital heart surgery in children may reflect unequal access to care. Pediatr Cardiol. 2003; 24: 103–108.CrossRefGoogle ScholarPubMed
DeMone, JA, Gonzalez, PC, Gauvreau, K, et al. Risk of death for Medicaid recipients undergoing congenital heart surgery. Pediatr Cardiol. 2003; 24: 97–102.CrossRefGoogle ScholarPubMed
Ghanayem, NS, Allen, KR, Tabbutt, S, et al. Interstage mortality after the Norwood procedure: results of the multicenter single ventricle reconstruction trial. J Thorac Cardiovasc Surg. 2012; 144: 896–906.CrossRefGoogle ScholarPubMed
Ravishankar, C, Gerstenberger, E, Sleeper, LA, et al. Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg. 2016; 151 669–675.CrossRefGoogle ScholarPubMed
Texter, K, Davis, JM, Phelps, C, et al. Building a comprehensive team for the longitudinal care of single ventricle heart defects: building blocks and initial results. Congenit Heart Dis. 2017; 12: 403–410.CrossRefGoogle ScholarPubMed
Ghanayem, NS, Hoffman, GM, Mussatto, KA, et al. Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg. 2003; 126: 1367–1377.CrossRefGoogle ScholarPubMed
Castellanos, DA, Herrington, C, Adler, S, Haas, K, Kumar, SR, Kung, GC. Home monitoring program reduces mortality in high-risk sociodemographic single-ventricle patients. Pediatr Cardiol. 2016; 37: 1575–1580.CrossRefGoogle ScholarPubMed
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