Document Detail


Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome.
MedLine Citation:
PMID:  20167337     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: There is debate whether primary or delayed sternal closure is the best strategy after stage 1 palliation for hypoplastic left heart syndrome. We describe center variation in delayed sternal closure after stage 1 palliation and associated outcomes.
METHODS: Society of Thoracic Surgeons Congenital Database participants performing stage 1 palliation for hypoplastic left heart syndrome from 2000 to 2007 were included. We examined center variation in delayed sternal closure and compared in-hospital mortality, prolonged length of stay (length of stay > 6 weeks), and postoperative infection in centers with low (< or = 25% of cases), middle (26%-74% of cases), and high (> or = 75% of cases) delayed sternal closure use, adjusting for patient and center factors.
RESULTS: There were 1283 patients (45 centers) included. Median age at surgery was 6 days (interquartile range, 4-9 days), and median weight at surgery was 3.2 kg (interquartile range, 2.8-3.5 kg); 59% were male. Delayed sternal closure was used in 74% of cases (range, 3%-100% of cases/center). In centers with high (n = 23) and middle (n = 17) versus low (n = 5) delayed sternal closure use, there was a greater proportion of patients with prolonged length of stay and infection, and a trend toward increased in-hospital mortality in unadjusted analysis. In multivariable analysis, there was no difference in mortality. Centers with high and middle delayed sternal closure use had prolonged length of stay (odds ratio, 2.83; 95% confidence interval, 1.46-5.47; P = .002 and odds ratio, 2.23; confidence interval, 1.17-4.26; P = .02, respectively) and more infection (odds ratio, 2.34; confidence interval, 1.20-4.57; P = .01 and odds ratio, 2.37; confidence interval, 1.36-4.16; P = .003, respectively).
CONCLUSION: Use of delayed sternal closure after stage 1 palliation varies widely. These observational data suggest that more frequent use of delayed sternal closure is associated with longer length of stay and higher postoperative infection rates. Further evaluation of the risks and benefits of delayed sternal closure in the management of these complex infants is necessary.
Authors:
Jason N Johnson; James Jaggers; Shuang Li; Sean M O'Brien; Jennifer S Li; Jeffrey P Jacobs; Marshall L Jacobs; Karl F Welke; Eric D Peterson; Sara K Pasquali
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-02-18
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  139     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-23     Completed Date:  2010-05-06     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1205-10     Citation Subset:  AIM; IM    
Copyright Information:
2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC 27715, USA.
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MeSH Terms
Descriptor/Qualifier:
Academies and Institutes / statistics & numerical data*
Cardiac Surgical Procedures / adverse effects,  mortality,  statistics & numerical data*
Databases as Topic
Female
Hospital Mortality
Hospitals / statistics & numerical data*
Humans
Hypoplastic Left Heart Syndrome / mortality,  surgery*
Infant, Newborn
Length of Stay / statistics & numerical data
Logistic Models
Male
Odds Ratio
Outcome and Process Assessment (Health Care) / statistics & numerical data*
Palliative Care
Physician's Practice Patterns / statistics & numerical data*
Risk Assessment
Risk Factors
Sternotomy / adverse effects,  mortality,  statistics & numerical data*
Surgical Wound Infection / etiology
Time Factors
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
KL2 RR024127-02/RR/NCRR NIH HHS; KL2 RR024127-02/RR/NCRR NIH HHS
Comments/Corrections

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