title: Practice Patterns in Postoperative Echocardiographic Surveillance after Congenital Heart Surgery in Children: A Single Center Experience.
abstract: To review current institutional practice and describe factors contributing to variation in inpatient postoperative imaging surveillance after congenital heart surgery.
  
  
  
  We reviewed records of all children who underwent congenital heart surgery from June to December 2014. Number and primary indications for postoperative transthoracic echocardiograms (TTEs), providers involved, cardiovascular intensive care unit (CVICU) and total hospital length of stay, and Risk-Adjustment for Congenital Heart Surgery-1 scores were recorded.
  
  
  
  A total of 253 children (age at surgery: 8 months [2 days-19 years]) received 556 postoperative TTEs (median 1 TTE/patient [1-14]), and 23% had ≥3 TTEs. Fifteen of 556 TTEs (2.7%) revealed a new abnormal finding. The majority of TTEs (59%) were performed in the CVICU (1.5 ± 1.1 TTEs/week/patient), with evaluation of function as the most common indication (44%). Attending physician practice >10 years was not associated with fewer TTEs (P = .12). Patients with ≥3 TTEs had higher Risk-Adjustment for Congenital Heart Surgery-1 scores (P = .001), longer CVICU lengths of stay (22 vs 3 days; P < .0001), longer overall hospitalizations (28 vs 7 days; P < .0001), and a higher incidence of mechanical circulatory support (10% vs 0%; P < .0001) than those with <3 TTEs. Eight patients with ≥3 TTEs did not survive, compared with 3 with <3 TTEs (P = .0004).
  
  
  
  There was wide intra-institutional variation in echocardiographic use among similar complexity surgeries. Frequency of postoperative echocardiographic surveillance was associated with degree of surgical complexity and severity of postoperative clinical condition. Few studies revealed new abnormal findings. These results may help establish evidence-based guidelines for inpatient echocardiographic surveillance after congenital heart surgery.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA. Electronic address: alisa.arunamata@stanford.edu.
authors.forename: Alisa
authors.initials: A
authors.lastname: Arunamata
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
authors.forename: David M
authors.initials: DM
authors.lastname: Axelrod
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Alaina K
authors.initials: AK
authors.lastname: Kipps
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Shin
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Inger L
authors.initials: IL
authors.lastname: Olson
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Elif Seda
authors.initials: ES
authors.lastname: Selamet Tierney
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055815:Young Adult
keywords: congenital heart disease; echocardiography; postoperative; surveillance