Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial.
BACKGROUND
The single-ventricle reconstruction trial randomized patients with single right ventricle lesions to a modified Blalock-Taussig or right ventricle-to-pulmonary artery shunt at the Norwood. This analysis describes outcomes at the stage 2 procedure and factors associated with a longer hospital length of stay (LOS).


METHODS
We examined the association of shunt type with stage 2 hospital outcomes. Cox regression and bootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associated with in-hospital death.


RESULTS
There were 393 subjects in the analytic cohort. Median stage 2 procedure hospital LOS (8 days; interquartile range [IQR], 6-14 days), hospital mortality (4.3%), transplantation (0.8%), median ventilator time (2 days; IQR, 1-3 days), median intensive care unit LOS (4 days; IQR, 3-7 days), number of additional cardiac procedures or complications, and serious adverse events did not differ by shunt type. Longer LOS was associated (R(2) = 0.26) with center, longer post-Norwood LOS (hazard ratio [HR], 1.93 per log day; P < .001), nonelective timing of the stage 2 procedure (HR, 1.78; P < .001), and pulmonary artery (PA) stenosis (HR, 1.56; P < .001). By univariate analysis, nonelective stage 2 (65% vs 32%; P = .009), moderate or greater atrioventricular valve (AVV) regurgitation (75% vs 24%; P < .001), and AVV repair (53% vs 9%; P < .001) were among the risk factors associated with in-hospital death.


CONCLUSIONS
Norwood LOS, PA stenoses, and nonelective stage 2 procedure, but not shunt type, are independently associated with longer LOS. Nonelective stage 2 procedure, moderate or greater AVV regurgitation, and need for AVV repair are among the risk factors for death.
Divisions of Cardiac Critical Care Medicine and Cardiology, Departments of Critical Care Medicine and Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: steven.schwartz@sickkids.ca.
Steven M
SM
Schwartz
New England Research Institutes, Watertown, Mass.
Minmin
M
Lu
Division of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Richard G
RG
Ohye
Division of Cardiology, Department of Pediatrics, Duke University, Durham, NC.
Kevin D
KD
Hill
Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Andrew M
AM
Atz
Division of Critical Care Medicine, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pa.
Maryam Y
MY
Naim
Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, NY.
Ismee A
IA
Williams
Division of Pediatric Cardiology, Department of Pediatrics & Communicable Diseases, University of Michigan Medical School, Ann Arbor, Mich.
Caren S
CS
Goldberg
Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, Calif.
Alan
A
Lewis
Department of Cardiac Surgery, Children's Hospital Boston, Boston, Mass.
Frank
F
Pigula
Division of Cardiovascular Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Peter
P
Manning
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Alfred I. duPont Hospital for Children, Wilmington, Del.
Christian
C
Pizarro
Division of Cardiovascular Surgery, All Children's Hospital, Tampa, Fla.
Paul
P
Chai
Division of Pediatric Cardiology, Department of Pediatrics, Primary Children's Medical Center, Salt Lake City, Utah.
Rachel
R
McCandless
Department of Cardiology, Children's Hospital Boston, Boston, Mass.
Carolyn
C
Dunbar-Masterson
Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.
Jonathan R
JR
Kaltman
Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, Ga.
Kirk
K
Kanter
New England Research Institutes, Watertown, Mass.
Lynn A
LA
Sleeper
New England Research Institutes, Watertown, Mass.
Julie V
JV
Schonbeck
Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wis.
Nancy
N
Ghanayem
D058366:Blalock-Taussig Procedure / Q000009:adverse effects* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D015999:Multivariate Analysis; D009656:North America; D058327:Norwood Procedures / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome