Quality outcomes of ACHD patients undergoing cardiovascular procedures and hospital admissions in a free-standing children's hospital.
OBJECTIVE
Describe quality outcomes of adults with congenital heart disease (ACHD) undergoing cardiovascular procedures and admissions in a free-standing children's hospital with a multi-disciplinary ACHD program and compared with pediatric outcomes.


BACKGROUND
A challenge for the U.S. healthcare system is where to treat the >1 million ACHD patients (pts): adult hospitals without CHD care, or pediatric hospitals without adult services.


METHODS
We reviewed all CHD pts ≥ 18 yrs of age from 2002-2007. Procedural and hospital related morbidity and mortality were recorded. ANOVA and t-test compared adult with pediatric pts.


RESULTS
Overall, 782 pts, mean age of 29.8 ± 9.9 yrs, encountered 1490 procedures/admissions. For 178 cardiac surgeries (72% reoperations), mortality was 1.8% and complication rate was 7.3%. There was 0% mortality for 412 cardiac catheterizations, 311 electrophysiological procedures, 401 transesophageal echocardiograms (TEE), 244 exercise tests (ETT) and 54 medical admissions. Major adverse event rate was 0.6% for cardiac catheterization and electrophysiological procedures. No adverse events occurred during TEE and ETT. Only 4 pts required transfer to an adult institution (0.25%). There was no significant difference in mortality or adverse events between pediatric and adult CHD pts, p>0.05.


CONCLUSIONS
The optimal setting to provide ACHD care remains a complex issue. Our study is the first to demonstrate 1) a low incidence of morbidity and mortality for ACHD pts undergoing cardiovascular procedures or admissions at a free-standing children's hospital, 2) outcomes comparable to pediatric CHD pts. Future models incorporating ACHD programs within pediatric heart centers should be considered to care for this complex population.
Crumb
Stephen R
SR
Nationwide Children's Hospital, Columbus, OH 43205, USA. stephen.crumb@nationwidechildrens.org
Cook
Stephen C
SC
Cheatham
John P
JP
Galantowicz
Mark
M
Feltes
Timothy F
TF
Phillips
Alistair
A
Chan
David P
DP
Holzer
Ralf J
RJ
Sisk
Matt
M
Olshove
Vince
V
Cook
Lindsey R
LR
Hickey
Jenne C
JC
Hill
Sharon L
SL
Daniels
Curt J
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011446:Prospective Studies; D011787:Quality of Health Care; D055815:Young Adult