Defining the best practice patterns for the neonatal systemic-to-pulmonary artery shunt procedure

The Journal of Thoracic and Cardiovascular Surgery
Giv Heidari-BateniPirooz Eghtesady

Abstract

To assess variation in outcome measures and their associations with shunt thrombosis prophylaxis regimens after systemic-to-pulmonary artery shunt surgery across centers in the United States participating in the Pediatric Health Information System database. We reviewed data on neonates who underwent an off-pump shunt procedure at 39 centers between 2000 and 2011. The overall variation in rates of discharge mortality and shunt-related complications were assessed by funnel plots. Complications were defined as revision/repeat of the shunt procedure during the same admission, institution of extracorporeal membrane oxygenation after surgery, and catheter interventions after shunt surgery. Bayesian hierarchical modeling was used to identify outliers. Shunt thrombosis prophylaxis regimens including the time of initiation of aspirin were compared between high and low outliers. A total of 2058 index operations were identified. Funnel plots highlighting the outcomes from various centers allowed discrimination of discharge mortality and complication rates around an aggregate of 6.7% and 12.3%, respectively. Bayesian modeling showed the presence of substantial variation in complication rates between centers; 20% of them were identified as ...Continue Reading

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Citations

Jan 16, 2016·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Dan Mihai DorobantuSerban Constantin Stoica
Aug 18, 2016·The Journal of Thoracic and Cardiovascular Surgery·Phil BothaKirk Kanter
Apr 26, 2018·World Journal for Pediatric & Congenital Heart Surgery·Bahaaldin Alsoufi
Mar 14, 2020·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Sirisha EmaniSitaram M Emani
Oct 24, 2017·JACC. Basic to Translational Science·Elisabeth A KazaThomas G Diacovo
Oct 21, 2020·Journal of Thrombosis and Haemostasis : JTH·Diana VargasThomas Diacovo

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