Hostname: page-component-77c89778f8-sh8wx Total loading time: 0 Render date: 2024-07-19T15:53:33.469Z Has data issue: false hasContentIssue false
  • English
  • Français

“In-patient echocardiography utilization post repair of congenital heart disease. Analysis of data from the Pediatric Health Information System from 2010 to 2019”

Published online by Cambridge University Press:  02 January 2024

Adam M. Skaff Open the ORCID record for Adam M. Skaff [Opens in a new window] ,
Nishma G. Valikodath ,
Justin Godown  and
David A. Parra
Adam M. Skaff*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
Nishma G. Valikodath
Affiliation:
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
Justin Godown
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
David A. Parra
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
*
Corresponding author: A. M. Skaff; Email: adam.skaff@louisville.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Echocardiography is a key diagnostic tool for medical decision-making following congenital heart surgery. Overall utilisation of echocardiography for specific congenital heart lesions following cardiac surgery has not previously been reported. This study aims to assess echocardiogram utilisation following the surgical repair of CHD to describe the variation in use across centres and provide clinical benchmarks.

Methods:

All patients < 18 years of age undergoing surgical repair of CHD were identified from the Pediatric Health Information System from 2010 to 2019. Surgeries were grouped based on their Risk Adjustment for Congenital Heart Surgery-1 scores. Detailed billing data were used to assess the frequency/cost of post-operative echocardiograms, phase of hospital care, and hospital length of stay.

Results:

In total, 37,238 surgical encounters were identified for inclusion across 48 centres. Higher Risk Adjustment for Congenital Heart Surgery scores were associated with an increased median number of post-operative echocardiograms (2 versus 4 in Risk Adjustment for Congenital Heart Surgery score 1 versus 6, p < 0.001), and longer median post-operative length of stay (3 days versus 31 days in Risk Adjustment for Congenital Heart Surgery score 1 versus 6, p < 0.001). After accounting for surgical complexity, there was significant variability in echocardiogram utilisation across centres (median daily echocardiogram utilisation range 0.2/day–0.6/day, p < 0.001). There is no difference in the proportion of patients with high surgical complexity (Risk Adjustment for Congenital Heart Surgery ≥ 4) between centres with high versus low echocardiogram utilisation (p = 0.44).

Conclusions:

Increasing surgical complexity is associated with longer post-operative length of stay and increased utilisation of echocardiography. There is wide variability in echocardiography resource utilisation across centres, even when accounting for surgical complexity.

Keywords

echocardiographypediatric cardiologyCHDutilisation
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 6
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chin, AJ, Vetter, JM, Seliem, M, et al. Role of early postoperative surface echocardiography in the pediatric cardiac intensive care unit. Chest 1994; 105: 10–16. DOI: 10.1378/chest.105.1.10.CrossRefGoogle ScholarPubMed
Kutty, S, Attebery, JE, Yeager, EM, et al. Transthoracic echocardiography in pediatric intensive care: impact on medical and surgical management. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 2014; 15: 329–335. DOI: 10.1097/PCC.0000000000000099.Google ScholarPubMed
Yang, JCT, Lin, MT, Jaw, FS, et al. Trends in the utilization of computed tomography and cardiac catheterization among children with congenital heart disease. J Formos Med Assoc Taiwan Yi Zhi 2015; 114: 1061–1068. DOI: 10.1016/j.jfma.2014.08.004.CrossRefGoogle ScholarPubMed
Anderson, S, Figueroa, J, McCracken, CE, et al. Factors influencing temporal trends in pediatric inpatient imaging utilization. J Am Soc Echocardiogr 2020; 33: 1517–1525. DOI: 10.1016/j.echo.2020.06.019.CrossRefGoogle ScholarPubMed
Lai, WW, Srivastava, S, Cohen, MS, et al. Pediatric echocardiography laboratory organization and clinical productivity. J Am Soc Echocardiogr 2013; 26: 1180–1186. DOI: 10.1016/j.echo.2013.06.019.CrossRefGoogle ScholarPubMed
Arunamata, A, Axelrod, DM, Kipps, AK, et al. Practice patterns in postoperative echocardiographic surveillance after congenital heart surgery in children: a single center experience. J Pediatr 2017; 180: 87–91.e1. DOI: 10.1016/j.jpeds.2016.09.061.CrossRefGoogle ScholarPubMed
Jenkins, KJ, Gauvreau, K, Newburger, JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118. DOI: 10.1067/mtc.2002.119064.CrossRefGoogle ScholarPubMed
Cavalcanti, PEF, de Sá M.P.B., O, Santos, CA, dos, etal. Stratification of complexity in congenital heart surgery: comparative study of the risk adjustment for congenital heart surgery (RACHS-1) method, Aristotle basic score and society of thoracic surgeons-european association for cardio- thoracic surgery (STS-EACTS) mortality score. Rev Bras Cir Cardiovasc Orgao Of Soc Bras Cir Cardiovasc 2015; 30: 148–158. DOI: 10.5935/1678-9741.20150001.Google ScholarPubMed
Gerberding, J, Popović, T, Solomon, S, et al. Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defects--United States, 2003. MMWR Morb Mortal Wkly Rep 2007; 56: 25–29.Google Scholar
Pasquali, SK, Thibault, D, Hall, M, et al. Evolving cost-quality relationship in pediatric heart surgery. Ann Thorac Surg 2022; 113: 866–873. DOI: 10.1016/j.athoracsur.2021.05.050.CrossRefGoogle ScholarPubMed
Azhar, AS, Aljefri, HM. Predictors of extended length of hospital stay following surgical repair of congenital heart diseases. Pediatr Cardiol 2018; 39: 1688–1699. DOI: 10.1007/s00246-018-1953-1.CrossRefGoogle ScholarPubMed
Supplementary material: File

Skaff et al. supplementary material
Download undefined(File)
File 148 KB