Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2011 Jun;127(6):e1482-9.
doi: 10.1542/peds.2010-2796. Epub 2011 May 16.

Care models and associated outcomes in congenital heart surgery

Danielle S Burstein  1 , Jeffrey P Jacobs, Jennifer S Li, Shubin Sheng, Sean M O'Brien, Anthony F Rossi, Paul A Checchia, Gil Wernovsky, Karl F Welke, Eric D Peterson, Marshall L Jacobs, Sara K Pasquali
Affiliations
Comparative Study

Care models and associated outcomes in congenital heart surgery

Danielle S Burstein et al. Pediatrics. 2011 Jun.

Abstract

Objective: Recently, there has been a shift toward care of children undergoing heart surgery in dedicated pediatric cardiac intensive care units (CICU). The impact of this trend on patient outcomes is unclear. We evaluated postoperative outcomes associated with a CICU versus other ICU models.

Patients and methods: Society of Thoracic Surgeons Congenital Heart Surgery Database participants (2007-2009) who completed an ICU survey were included. In multivariable analysis, we evaluated outcomes associated with a CICU versus other ICUs, adjusting for center volume, patient factors, and Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery surgical risk category.

Results: A total of 20 922 patients (47 centers; 25 with a CICU) were included. Overall unadjusted mortality was 3.8%, median length of stay was 6 days (interquartile range: 4-13), and 21% had 1 or more complications. In multivariable analysis, there was no difference in mortality comparing CICUs versus other ICUs (odds ratio: 0.88 [95% confidence interval: 0.65-1.19]). In stratified analysis, CICUs were associated with lower mortality only among those in Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category 3 (odds ratio: 0.47 [95% confidence interval: 0.25-0.86]), primarily related to atrioventricular canal repair and arterial switch operation. There was no difference in length of stay or complications overall or in stratified analysis.

Conclusions: We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Adjusted outcomes associated with a CICU; overall and stratified by STS-EACTS risk category. A, In-hospital mortality. B, Postoperative length of stay (log days). C, Postoperative complications. OR indicates odds ratio; CI, confidence interval.
See this image and copyright information in PMC

Comment in

References

    1. Boneva RS, Botto LD, Moore CA, et al. Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation. 2001;103(19):2376–2381 - PubMed
    1. Chang AC. Pediatric cardiac intensive care: current state of the art and beyond the millennium. Curr Opin Pediatr. 2000;12(3):238–246 - PubMed
    1. Chang AC. How to start and sustain a successful pediatric cardiac intensive care program: a combined clinical and administrative strategy. Pediatr Crit Care Med. 2002;3(2):107–111 - PubMed
    1. Burstein D, Rossi A, Jacobs J, et al. Variation in models of care delivery for children undergoing congenital heart surgery in the United States. World Journal for Pediatric and Congenital Heart Surgery. 2010;1:8–14 - PMC - PubMed
    1. US News and World Report US News and World Report's America's best children's hospitals [article online]. Available at: www.rti.org/besthospitals Accessed May 20, 2010

Publication types