Impact of reintervention during stage 1 palliation hospitalization: A national, multicenter study


Advocate Children's Hospital


Background: Stage 1 palliation (S1P) for hypoplastic left heart syndrome remains associated with high morbidity and mortality. Prior studies on burden of reinterventions do not include patients who remain hospitalized prior to stage 2 palliation (S2P). This study describes the rate of reintervention during S1P hospitalization and seeks to determine the impact of reintervention on outcomes.

Methods: All participants enrolled in Phase II of the National Pediatric Cardiology Quality Improvement Collaborative post-S1P are included in this study. Primary outcome is rate of reintervention during hospitalization post-S1P prior to hospital discharge or S2P. Reintervention is defined as one or more unplanned interventional cardiac catheterizations and/or surgical reoperations.

Results: Between 3/1/16-10/1/19, 1367 participants underwent S1P and 339 (24.8%) had a reintervention; most commonly to address the source of pulmonary blood flow. Gestational age, weight at S1P, atrioventricular septal defect, heterotaxy, pre-operative pulmonary artery bands, hybrid S1P and an additional bypass run or early extracorporeal membrane oxygenation were significantly associated with reintervention. Participants in the reintervention group experienced higher rates for nearly all postoperative complications, were less likely to be discharged prior to S2P (57.1% vs 86%, p< 0.001) and more likely to suffer in-hospital mortality (17% vs 5%, p<0.001).

Conclusions: Unplanned reintervention during hospitalization following S1P palliation occurred in 25% of participants in a large, registry based national cohort. Participants who underwent reintervention were more likely to remain inpatient and less likely to survive to S2P. Reintervention was associated with a multitude of postoperative complications that impact survival and long-term outcome.

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