Association of 24/7 In-House Intensive Care Unit Attending Physician Coverage With Outcomes in Children Undergoing Heart Operations.

Abstract

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.

• Authors: Punkaj Gupta, Mallikarjuna Rettiganti, Howard E Jeffries, Nancy Brundage, Barry P Markovitz, Matthew C Scanlon, Janet M Simsic
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 102 Issue 6 Pg. 2052-2061 (Dec 2016) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 27324525 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Cardiac Surgical Procedures
• Child
• Child, Preschool
• Critical Care
• Databases, Factual
• Female
• Heart Defects, Congenital (complications, mortality, surgery)
• Humans
• Infant
• Intensive Care Units, Pediatric
• Male
• Medical Staff, Hospital
• Personnel Staffing and Scheduling
• Propensity Score
• Workload