title: Duration of Mechanical Ventilation and Perioperative Care Quality After Neonatal Cardiac Operations.
abstract: BACKGROUND
  This study was conducted to determine whether the duration of mechanical ventilation (DOMV) could be used to benchmark the overall quality of care after neonatal congenital heart operations.
  
  
  METHODS
  Children aged younger than 30 days undergoing cardiac operations were reviewed. Technical adequacy was assessed using the Technical Performance Score (TPS), a previously validated tool for determining the adequacy of a palliative or corrective surgical procedure that uses echocardiography criteria and need for unplanned reintervention to determine technical adequacy. Preoperative risk factors and postoperative complications were determined using The Society of Thoracic Surgeons Congenital Heart Surgery Database definitions. Surgical complexity was assessed using The Society of Thoracic Surgeons-European Association of Cardio-Thoracic Surgery (STAT) Mortality Categories. We explored associations between preoperative risk factors, STAT category, TPS, and postoperative complications with DOMV.
  
  
  RESULTS
  Of 601 patients studied, 49 were not included in the multivariable analysis due to a STAT nonclassifiable operation or unmeasured TPS, or both. Multiple risk factors were associated with longer DOMV, including weight (p = 0.005), The Society of Thoracic Surgeons Congenital Heart Surgery Database preoperative factors (p = 0.005), STAT mortality category (p < 0.001), TPS (p < 0.001), and The Society of Thoracic Surgeons Congenital Heart Surgery Database-defined complications (p < 0.001). Multivariable regression showed that preoperative factors increased DOMV by 1.23 days (p = 0.01), class 3 TPS by 2.16 days (p < 0.001), and postoperative complications by 2.03 days (p < 0.001), with adjusted R2= 0.42.
  
  
  CONCLUSIONS
  Neonates with major residual lesions and postoperative complications have prolonged DOMV. DOMV may reflect the quality of care after congenital heart operations.
authors.affiliation: Division of Cardiac Critical Care, Department of Anesthesia/Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: blinderj@email.chop.edu.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Blinder
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ravi
authors.initials: R
authors.lastname: Thiagarajan
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Williams
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Mayer
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kulik
mesh_terms: D019985:Benchmarking / Q000379:methods*; D006348:Cardiac Surgical Procedures; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D019990:Perioperative Care; D011183:Postoperative Complications; D011787:Quality of Health Care; D012121:Respiration, Artificial; D013997:Time Factors; D014481:United States