title: Care models and associated outcomes in congenital heart surgery.
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.
  
  
  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 .
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA. sara.pasquali@duke.edu
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Burstein
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Shubin
authors.initials: S
authors.lastname: Sheng
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Rossi
authors.forename: Paul A
authors.initials: PA
authors.lastname: Checchia
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
mesh_terms: D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome