title: Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient.
abstract: BACKGROUND
  Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention.
  
  
  METHODS
  After institution of a clinical practice guideline for management of postoperative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed 2 cohorts of patients: those with chylothorax from January 2008 to May 2010 (early cohort; n=118) and from June 2010 to August 2011 (late cohort; n=45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization.
  
  
  RESULTS
  There were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to chylothorax diagnosis (9 in early cohort versus 6 days in late cohort, p=0.004), ICU length of stay (18 vs 9 days, p=0.01), hospital length of stay (30 vs 23 days, p=0.005), and total durations of mechanical ventilation (11 vs 5 days, p=0.02), chest tube use (20 vs 14 days, p=0.01), central venous line use (27 vs 15 days, p=0.001), and NPO status (9.5 vs 6 days, p=0.04).
  
  
  CONCLUSIONS
  Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.
authors.affiliation: Division of Pediatric Cardiology, Department of Cardiac Surgery, University of Michigan, C.S. Mott Children's Hospital Ann Arbor, Michigan 48109-4204, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Yeh
authors.forename: Erin R
authors.initials: ER
authors.lastname: Brown
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kellogg
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Gaies
authors.forename: Carlen G
authors.initials: CG
authors.lastname: Fifer
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch
authors.forename: Ranjit
authors.initials: R
authors.lastname: Aiyagari
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002916:Chylothorax / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 18; BSI; CPG; CVL; EC; ICU; LC; NPO; RACHS-1; Risk Adjustment for Congenital Heart Surgery; TPN; bloodstream infections; central venous line; clinical practice guideline; early cohort; intensive care unit; late cohort; nil per os; total parenteral nutrition
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