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. 2018 May 16;7(11):e008719.
doi: 10.1161/JAHA.118.008719.

Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

Laura Mercer-Rosa  1   2 , Okan U Elci  3 , Grace DeCost  4   2 , Stacy Woyciechowski  4   2 , Sharon M Edman  4   2 , Chitra Ravishankar  4   2 , Christopher E Mascio  4   2 , Steven M Kawut  5 , Elizabeth Goldmuntz  4   2
Affiliations

Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

Laura Mercer-Rosa et al. J Am Heart Assoc. .

Abstract

Background: We sought to identify patient and surgical factors associated with time to hospital discharge in patients undergoing complete repair for tetralogy of Fallot.

Methods and results: We performed a prospective cohort study of patients with tetralogy of Fallot admitted for complete repair between May 1, 2012 and June 2, 2017 at Children's Hospital of Philadelphia with detailed demographic, clinical, and operative characteristics. The primary outcome was time to hospital discharge. Cox proportional hazards models were used to identify patient and operative predictors of time to hospital discharge. We enrolled 151 subjects, 62.8% male, 65.6% non-Hispanic white, and 9.9% non-Hispanic black. The median time to hospital discharge was 7 days (interquartile range 4, 12). Five patients died in the hospital, all of whom underwent tetralogy of Fallot repair beyond the neonatal period. Greater birth weight was associated with higher rate of hospital discharge (hazard ratio [HR]=1.35, 95% confidence interval (CI) =1.11, 1.64), while absent pulmonary valve versus pulmonary stenosis (HR=0.27, 95% CI=0.08, 0.91), pulmonary valve atresia versus pulmonary stenosis (HR=0.57, 95% CI=0.33, 0.97), presence of aortopulmonary collaterals (HR=0.44, 95% CI=0.24, 0.84), complete repair performed in the neonatal period (<30 days of life) (HR=0.45, 95% CI=0.27, 0.75), more than 1 cardiopulmonary bypass run (HR=0.33, 95% CI=0.18, 0.61), and longer aortic cross-clamp time (HR [per 10 minutes]=0.88, 95% CI=0.79, 0.97) were associated with lower rate of hospital discharge.

Conclusions: Postoperative hospital stay after complete repair of tetralogy of Fallot is in part determined by patient and operative factors. Some (eg, surgical strategy for the symptomatic neonate) may be modifiable. These results may impact patient counseling, choice of surgical approach, and postoperative care.

Keywords: hospital stay; outcome; surgery; tetralogy of Fallot.

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Figures

Figure 1
Figure 1
Figures A through F depict the survival function of being in the hospital postoperatively, adjusted by surgeon, and stratified by: A) Birth weight, B) Pulmonary valve anatomy, C) Presence of aorto‐pulmonary collateral vessels, D) Timing of complete TOF repair, E) Aortic cross clamp time, and F) Number of cardiopulmonary bypass runs. CPB indicates cardiopulmonary bypass; TOF, tetralogy of Fallot.
See this image and copyright information in PMC

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