Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspective
Objective: The study objective was to provide a detailed overview of health resource use from birth to 18 years old for patients with functionally single ventricles and identify associated risk factors. Methods: All patients with functionally single ventricles treated between 2000 and 2017 in Englan...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-06-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266627362300089X |
| _version_ | 1797796136369520640 |
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| author | Dan-Mihai Dorobantu, MD Qi Huang, PhD Ferran Espuny Pujol, PhD Katherine L. Brown, MD, MPH Rodney C. Franklin, MD, FRCP Maria Pufulete, PhD Deborah A. Lawlor, PhD, MSc, MBChB Sonya Crowe, PhD Christina Pagel, PhD Serban C. Stoica, MD, FRCS |
| author_facet | Dan-Mihai Dorobantu, MD Qi Huang, PhD Ferran Espuny Pujol, PhD Katherine L. Brown, MD, MPH Rodney C. Franklin, MD, FRCP Maria Pufulete, PhD Deborah A. Lawlor, PhD, MSc, MBChB Sonya Crowe, PhD Christina Pagel, PhD Serban C. Stoica, MD, FRCS |
| author_sort | Dan-Mihai Dorobantu, MD |
| collection | DOAJ |
| description | Objective: The study objective was to provide a detailed overview of health resource use from birth to 18 years old for patients with functionally single ventricles and identify associated risk factors. Methods: All patients with functionally single ventricles treated between 2000 and 2017 in England and Wales were linked to hospital and outpatient records using data from the Linking AUdit and National datasets in Congenital HEart Services project. Hospital stay was described in yearly age intervals, and associated risk factors were explored using quantile regression. Results: A total of 3037 patients with functionally single ventricles were included, 1409 (46.3%) undergoing a Fontan procedure. During the first year of life, the median days spent in hospital was 60 (interquartile range, 37-102), mostly inpatient days, mirroring a mortality of 22.8%. This decreases to between 2 and 9 in-hospital days/year afterward. Between 2 and 18 years, most hospital days were outpatient, with a median of 1 to 5 days/year. Lower age at the first procedure, hypoplastic left heart syndrome/mitral atresia, unbalanced atrioventricular septal defect, preterm birth, congenital/acquired comorbidities, additional cardiac risk factors, and severity of illness markers were associated with fewer days at home and more intensive care unit days in the first year of life. Only markers of early severe illness were associated with fewer days at home in the first 6 months after the Fontan procedure. Conclusions: Hospital resource use in functionally single ventricle cases is not uniform, decreasing 10-fold during adolescence compared with the first year of life. There are subsets of patients with worse outcomes during their first year of life or with persistently high hospital use throughout their childhood, which could be the target of future research. |
| first_indexed | 2024-03-13T03:28:32Z |
| format | Article |
| id | doaj.art-9db344179b5b4bb888946600bc52db79 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-13T03:28:32Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-9db344179b5b4bb888946600bc52db792023-06-25T04:43:46ZengElsevierJTCVS Open2666-27362023-06-0114441461Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspectiveDan-Mihai Dorobantu, MD0Qi Huang, PhD1Ferran Espuny Pujol, PhD2Katherine L. Brown, MD, MPH3Rodney C. Franklin, MD, FRCP4Maria Pufulete, PhD5Deborah A. Lawlor, PhD, MSc, MBChB6Sonya Crowe, PhD7Christina Pagel, PhD8Serban C. Stoica, MD, FRCS9Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom; Population Health Sciences, University of Bristol, Bristol, United Kingdom; University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom; Address for reprints: Dan-Mihai Dorobantu, MD, Children's Health and Exercise Research Centre, Public Health and Sports Sciences, University of Exeter Medical School, Faculty of Life and Health Sciences, St Luke's Campus, Heavitree Rd, Exeter, EX1 2LU, United Kingdom.Clinical Operational Research Unit, Department of Mathematics, University College London, London, United KingdomClinical Operational Research Unit, Department of Mathematics, University College London, London, United KingdomCardiac and Critical Care Division, Great Ormond Street Hospital National Health Service Foundation Trust, London, United KingdomDepartment of Paediatric Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United KingdomBristol Heart Institute, University of Bristol, Bristol, United KingdomPopulation Health Sciences, University of Bristol, Bristol, United Kingdom; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Bristol National Institute for Health Research Biomedical Research Centre, Bristol, United KingdomClinical Operational Research Unit, Department of Mathematics, University College London, London, United KingdomClinical Operational Research Unit, Department of Mathematics, University College London, London, United KingdomUniversity Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United KingdomObjective: The study objective was to provide a detailed overview of health resource use from birth to 18 years old for patients with functionally single ventricles and identify associated risk factors. Methods: All patients with functionally single ventricles treated between 2000 and 2017 in England and Wales were linked to hospital and outpatient records using data from the Linking AUdit and National datasets in Congenital HEart Services project. Hospital stay was described in yearly age intervals, and associated risk factors were explored using quantile regression. Results: A total of 3037 patients with functionally single ventricles were included, 1409 (46.3%) undergoing a Fontan procedure. During the first year of life, the median days spent in hospital was 60 (interquartile range, 37-102), mostly inpatient days, mirroring a mortality of 22.8%. This decreases to between 2 and 9 in-hospital days/year afterward. Between 2 and 18 years, most hospital days were outpatient, with a median of 1 to 5 days/year. Lower age at the first procedure, hypoplastic left heart syndrome/mitral atresia, unbalanced atrioventricular septal defect, preterm birth, congenital/acquired comorbidities, additional cardiac risk factors, and severity of illness markers were associated with fewer days at home and more intensive care unit days in the first year of life. Only markers of early severe illness were associated with fewer days at home in the first 6 months after the Fontan procedure. Conclusions: Hospital resource use in functionally single ventricle cases is not uniform, decreasing 10-fold during adolescence compared with the first year of life. There are subsets of patients with worse outcomes during their first year of life or with persistently high hospital use throughout their childhood, which could be the target of future research.http://www.sciencedirect.com/science/article/pii/S266627362300089XFontanhospital length of stayhospital resourceshypoplastic left heart syndromeNorwoodregistry |
| spellingShingle | Dan-Mihai Dorobantu, MD Qi Huang, PhD Ferran Espuny Pujol, PhD Katherine L. Brown, MD, MPH Rodney C. Franklin, MD, FRCP Maria Pufulete, PhD Deborah A. Lawlor, PhD, MSc, MBChB Sonya Crowe, PhD Christina Pagel, PhD Serban C. Stoica, MD, FRCS Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspective JTCVS Open Fontan hospital length of stay hospital resources hypoplastic left heart syndrome Norwood registry |
| title | Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspective |
| title_full | Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspective |
| title_fullStr | Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspective |
| title_full_unstemmed | Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspective |
| title_short | Hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentCentral MessagePerspective |
| title_sort | hospital resource utilization in a national cohort of functionally single ventricle patients undergoing surgical treatmentcentral messageperspective |
| topic | Fontan hospital length of stay hospital resources hypoplastic left heart syndrome Norwood registry |
| url | http://www.sciencedirect.com/science/article/pii/S266627362300089X |
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