Association of 24/7 In-House Intensive Care Unit Attending Physician Coverage With Outcomes in Children Undergoing Heart Operations.
BACKGROUND
Multicenter data regarding the around-the-clock (24/7) presence of an in-house critical care attending physician with outcomes in children undergoing cardiac operations are limited.


METHODS
Patients younger than 18 years of age who underwent operations (with or without cardiopulmonary bypass [CPB]) for congenital heart disease at 1 of the participating intensive care units (ICUs) in the Virtual PICU Systems (VPS, LLC) database were included (2009-2014). The study population was divided into 2 groups: the 24/7 group (14,737 patients; 32 hospitals), and the No 24/7 group (10,422 patients; 22 hospitals). Propensity-score matching was performed to match patients 1:1 in the 24/7 group and in the No 24/7 group.


RESULTS
Overall, 25,159 patients from 54 hospitals qualified for inclusion. By propensity matching, 9,072 patients (4,536 patient pairs) from 51 hospitals were matched 1:1 in the 2 groups. After matching, mortality at ICU discharge was lower among the patients treated in hospitals with 24/7 coverage (24/7 versus No 24/7, 2.8% versus 4.0%; p = 0.002). The use of extracorporeal membrane oxygenation (ECMO), the incidence of cardiac arrest, extubation within 48 hours after operation, the rate of reintubation, and the duration of arterial line and central venous line use after operation were significantly improved in the 24/7 group. When stratified by surgical complexity, survival benefits of 24/7 coverage persisted among patients undergoing both high-complexity and low-complexity operations.


CONCLUSIONS
The presence of 24-hour in-ICU attending physician coverage in children undergoing cardiac operations is associated with improved outcomes, including ICU mortality. It is possible that 24-hour in-ICU attending physician coverage may be a surrogate for other factors that may bias the results. Further study is warranted.
Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: pgupta2@uams.edu.
Punkaj
P
Gupta
Section of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Mallikarjuna
M
Rettiganti
Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.
Howard E
HE
Jeffries
Virtual PICU Systems, LLC, Los Angeles, California.
Nancy
N
Brundage
Virtual PICU Systems, LLC, Los Angeles, California; Division of Critical Care Medicine, Department of Pediatrics and Anesthesiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
Barry P
BP
Markovitz
Virtual PICU Systems, LLC, Los Angeles, California; Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Matthew C
MC
Scanlon
Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Janet M
JM
Simsic
D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008505:Medical Staff, Hospital; D010561:Personnel Staffing and Scheduling; D057216:Propensity Score; D016526:Workload