title: Preoperative Intubation and Lack of Enteral Nutrition are Associated with Prolonged Stay After Arterial Switch Operation.
abstract: Mortality for the arterial switch operation (ASO) has diminished significantly over the past few decades. Some patients do, however, continue to have protracted and complicated courses after surgery. We attempted to determine which preoperative factors were best associated with prolonged hospital stay after ASO. We retrospectively reviewed all patients that underwent an ASO over a 10-year period. Outcomes of patients with postoperative stays (POS) >14 days (long stay group-LS) were compared with those patients with POS < 7 days (short stay group-SS). The following variables were evaluated: age at surgery, weight, septostomy performed (BAS) and management the day prior to surgery including use of prostaglandin E1 (PGE1), inotropes, intubation status and the establishment of enteral feeds. The SS group had 25 patients and the LS group had 32 patients. Both groups (SS vs. LS) were similar in PGE1 use (48 vs. 69 %), BAS (76 vs. 59 %), age at surgery (6 vs. 7 days) and preoperative inotropes (12 vs. 38 %). The SS group had significantly higher incidence of preoperative feeding (80 vs. 31 %, p < 0.001) and less frequent intubation (12 vs. 47 %, p < 0.001). Patients who are intubated and have not yet begun to receive enteral feeds at the time of their ASO are more likely to have prolonged POS. It is unclear if prolonged stays were a result of operating on patients with worse preoperative hemodynamics or a consequence of a preoperative management strategy that did not allow for extubation and establishment of feeds prior to surgery.
authors.affiliation: Division of Cardiac Intensive Care, Miami Children's Hospital, Miami, FL, USA. ilias.iliopoulos@cchmc.org.|Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-3026, USA. ilias.iliopoulos@cchmc.org.
authors.forename: Ilias
authors.initials: I
authors.lastname: Iliopoulos
authors.affiliation: Division of Cardiac Intensive Care, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Redmond
authors.initials: R
authors.lastname: Burke
authors.affiliation: Division of Cardiac Intensive Care, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hannan
authors.affiliation: Division of Cardiac Intensive Care, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Bolivar
authors.affiliation: Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-3026, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.affiliation: Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-3026, USA.
authors.forename: Farhan
authors.initials: F
authors.lastname: Zafar
authors.affiliation: Division of Cardiac Intensive Care, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rossi
mesh_terms: D000069278:Arterial Switch Operation; D004750:Enteral Nutrition; D006801:Humans; D007440:Intubation; D007902:Length of Stay; D011184:Postoperative Period
keywords: Arterial switch; Congenital heart disease; Length of stay; Preoperative enteral feeds; Preoperative intubation; Risk factors