title: Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease.
abstract: We aimed to further validate the vasoactive-ventilation-renal score as a predictor of outcome in patients recovering from surgery for congenital heart disease. We also sought to determine the optimal time point within the early recovery period at which the vasoactive-ventilation-renal score should be measured.
  
  
  
  We prospectively reviewed consecutive patients recovering from cardiac surgery within our intensive care unit between January 2015 and June 2015. The vasoactive-ventilation-renal score was calculated at 6, 12, 24, and 48 hours postoperatively as follows: vasoactive-ventilation-renal score = ventilation index + vasoactive-inotrope score + Δ creatinine [change in serum creatinine from baseline*10]. Primary outcome of interest was prolonged hospital length of stay, defined as length of stay in the upper 25%. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling also was performed.
  
  
  
  We reviewed 164 patients with a median age of 9.25 months (interquartile range, 2.6-58 months). Median length of stay was 8 days (interquartile range, 5-17.5 days). The area under the curve value for the vasoactive-ventilation-renal score as a predictor of prolonged length of stay (>17.5 days) was greatest at 12 hours postoperatively (area under the curve = 0.93; 95% confidence interval, 0.89-0.97). On multivariable regression analysis, after adjustment for potential confounders, the 12-hour vasoactive-ventilation-renal score remained a strong predictor of prolonged hospital length of stay (odds ratio, 1.15; 95% confidence interval, 1.10-1.20).
  
  
  
  In a heterogeneous population of patients undergoing surgery for congenital heart disease, the novel vasoactive-ventilation-renal score calculated in the early postoperative recovery period can be a strong predictor of prolonged hospital length of stay.
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
authors.forename: Bradley
authors.initials: B
authors.lastname: Scherer
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, Ind.
authors.forename: Elizabeth A S
authors.initials: EA
authors.lastname: Moser
authors.affiliation: Department of Cardiac Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
authors.affiliation: Department of Cardiac Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Rodefeld
authors.affiliation: Department of Cardiac Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
authors.affiliation: Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind. Electronic address: cmastrop@iupui.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
mesh_terms: D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents
keywords: assessment; cardiac; congenital; heart defects; intensive care units; neonatal; patient outcomes; pediatric; postoperative care; surgery