Adam M Skaff, Sandra D Kikano, Jeffrey G Weiner, Genevieve E Staudt, Patrick O Maynord, David P Bichell, David A Parra
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A post-Fontan management pathway was implemented (2020-2021) utilising post-operative vasopressin, nasal cannula oxygen until chest tube removal, and discharge regimen of three times daily diuretics, sildenafil, and afterload reducing medications. Patients were followed to evaluate primary outcomes.</p><p><strong>Results: </strong>The pre- and post-pathway groups were similar in single ventricle morphology, demographics, and pre-operative haemodynamics. Forty-three and 36 patients were included in the pre- and post-pathway cohorts, respectively. There were statistically significant reductions in chest tube duration (8 vs. 5 days, <i>p</i> ≤ 0.001), chest tube output on post-operative day 4 (20.4 vs. 9.9 mL/kg/day, <i>p</i> = 0.003), and hospital readmission rates for effusion (13[30%] vs. 3[8%], <i>p</i> = 0.02) compared to baseline. There was an absolute reduction in hospital length of stay (11 vs. 9.5 days, <i>p</i> = 0.052). When combining average cost savings for the Fontan hospitalisations, readmissions for effusion, and cardiac catheterisations within 6 months of Fontan completion, there was a $325,144 total cost savings for 36 patients following pathway implementation.</p><p><strong>Conclusion: </strong>Implementation of a post-Fontan management pathway resulted in significant reductions in chest tube duration and output, and readmission rates for effusion in the perioperative period.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Utilisation of a post-Fontan management pathway reduces chest tube drainage and hospital readmission rates.\",\"authors\":\"Adam M Skaff, Sandra D Kikano, Jeffrey G Weiner, Genevieve E Staudt, Patrick O Maynord, David P Bichell, David A Parra\",\"doi\":\"10.1017/S1047951124025861\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Complications following the Fontan procedure include prolonged pleural drainage and readmission for effusions. To address these complications, a post-Fontan management pathway was implemented with primary goals of reducing chest tube duration/reinsertion rates and decreasing hospital length of stay and readmissions.</p><p><strong>Methods: </strong>Fontan patients were identified by retrospective chart review (2017-2019) to obtain baseline data for chest tube duration/reinsertion rates, hospital length of stay, and readmission rates for effusion. A post-Fontan management pathway was implemented (2020-2021) utilising post-operative vasopressin, nasal cannula oxygen until chest tube removal, and discharge regimen of three times daily diuretics, sildenafil, and afterload reducing medications. Patients were followed to evaluate primary outcomes.</p><p><strong>Results: </strong>The pre- and post-pathway groups were similar in single ventricle morphology, demographics, and pre-operative haemodynamics. Forty-three and 36 patients were included in the pre- and post-pathway cohorts, respectively. 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引用次数: 0
摘要
背景:丰坦手术后的并发症包括胸腔引流时间过长和因积液再次入院。为解决这些并发症,实施了丰坦术后管理路径,主要目标是缩短胸管持续时间/重新插入率,减少住院时间和再入院率:通过回顾性病历审查(2017-2019 年)确定了丰坦患者,以获得胸管持续时间/重新插入率、住院时间和因积液再入院率的基线数据。实施了一条Fontan术后管理路径(2020-2021年),利用术后血管加压素、鼻导管供氧直至胸管拔除,以及每日三次的利尿剂、西地那非和减轻后负荷药物的出院方案。对患者进行随访以评估主要结果:结果:在单心室形态、人口统计学和术前血流动力学方面,路径前组和路径后组相似。途径前组和途径后组分别纳入了 43 名和 36 名患者。与基线相比,胸导管持续时间(8 天 vs. 5 天,p ≤ 0.001)、术后第 4 天胸导管输出量(20.4 vs. 9.9 mL/kg/天,p = 0.003)和因积液再入院率(13[30%] vs. 3[8%],p = 0.02)均有统计学意义上的显著减少。住院时间绝对缩短(11 天 vs. 9.5 天,p = 0.052)。如果将丰坦住院、因积液再入院和丰坦术后6个月内的心导管手术的平均成本节约额合并计算,实施路径后,36名患者的总成本节约了325,144美元:结论:实施丰坦术后管理路径后,胸管插管时间和输出量以及围手术期积液再入院率显著减少。
Utilisation of a post-Fontan management pathway reduces chest tube drainage and hospital readmission rates.
Background: Complications following the Fontan procedure include prolonged pleural drainage and readmission for effusions. To address these complications, a post-Fontan management pathway was implemented with primary goals of reducing chest tube duration/reinsertion rates and decreasing hospital length of stay and readmissions.
Methods: Fontan patients were identified by retrospective chart review (2017-2019) to obtain baseline data for chest tube duration/reinsertion rates, hospital length of stay, and readmission rates for effusion. A post-Fontan management pathway was implemented (2020-2021) utilising post-operative vasopressin, nasal cannula oxygen until chest tube removal, and discharge regimen of three times daily diuretics, sildenafil, and afterload reducing medications. Patients were followed to evaluate primary outcomes.
Results: The pre- and post-pathway groups were similar in single ventricle morphology, demographics, and pre-operative haemodynamics. Forty-three and 36 patients were included in the pre- and post-pathway cohorts, respectively. There were statistically significant reductions in chest tube duration (8 vs. 5 days, p ≤ 0.001), chest tube output on post-operative day 4 (20.4 vs. 9.9 mL/kg/day, p = 0.003), and hospital readmission rates for effusion (13[30%] vs. 3[8%], p = 0.02) compared to baseline. There was an absolute reduction in hospital length of stay (11 vs. 9.5 days, p = 0.052). When combining average cost savings for the Fontan hospitalisations, readmissions for effusion, and cardiac catheterisations within 6 months of Fontan completion, there was a $325,144 total cost savings for 36 patients following pathway implementation.
Conclusion: Implementation of a post-Fontan management pathway resulted in significant reductions in chest tube duration and output, and readmission rates for effusion in the perioperative period.
期刊介绍:
Cardiology in the Young is devoted to cardiovascular issues affecting the young, and the older patient suffering the sequels of congenital heart disease, or other cardiac diseases acquired in childhood. The journal serves the interests of all professionals concerned with these topics. By design, the journal is international and multidisciplinary in its approach, and members of the editorial board take an active role in the its mission, helping to make it the essential journal in paediatric cardiology. All aspects of paediatric cardiology are covered within the journal. The content includes original articles, brief reports, editorials, reviews, and papers devoted to continuing professional development.