Emergency department utilisation and critical readmission in patients with Fontan circulation
| Autor: | Christopher W. Mastropietro, Cailyn Rood, Katherine Cashen, Sheila F Waslawski, Daniel T. Cater, James E. Slaven, Tara L. Petersen |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Disease Cardiac catheterisation 030204 cardiovascular system & hematology Fontan Procedure Patient Readmission Fontan circulation Fontan procedure 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans In patient 030212 general & internal medicine Child Retrospective Studies Retrospective review business.industry General Medicine Emergency department Hospitalization Patient population Pediatrics Perinatology and Child Health Emergency medicine Cardiology and Cardiovascular Medicine business Emergency Service Hospital |
| Zdroj: | Cardiology in the young. 30(12) |
| ISSN: | 1467-1107 1047-9511 |
| Popis: | Background:We aimed to conduct a multi-centre study characterising emergency department utilisation and critical readmissions experienced by children with Fontan circulation.Methods:We conducted a retrospective review of children who underwent the Fontan operation at three institutions (i.e., centres A, B, and C) between 2009 and 2014, with follow-up through December 2015. Multi-variable analyses were performed to determine factors associated for emergency department utilisation within 1 year of surgery, emergency department utilisation at any time following surgery, or critical readmission (defined as admission to ICU, operating room, or cardiac catheterisation).Results:We reviewed 297 patients, of which 147 patients (49%) had 607 emergency department encounters. Forty-six patients (15%) required 71 critical readmissions. Multi-variable analyses revealed centre C (p = 0.02) and post-operative hospitalisation ≥ 14 days (p = 0.03) to be significantly associated with emergency department utilisation within 1 year, whereas centre B (p < 0.001), post-operative hospitalisation ≥ 14 days (p = 0.002), and African-American/Black race (p = 0.04) were significantly associated with critical readmission.Conclusions:In this multi-centre study, nearly half of patients with Fontan circulation received emergency department care, often presenting with high disease acuity requiring readmission. Emergency department utilisation and need for critical readmission were independently influenced by the centre at which surgery was performed, prolonged post-operative hospitalisation, and racial background. These data could help guide quality improvement efforts aimed at reducing morbidity in this unique patient population. |
| Databáze: | OpenAIRE |
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