Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals
| Autor: | Michael Gaies, John M. Costello, Brian D. Benneyworth, Darren Klugman, Christopher W. Mastropietro, Wenying Zhang, Eric M. Graham |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Heart Defects
Congenital Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology Risk Assessment law.invention 03 medical and health sciences 0302 clinical medicine Risk Factors law Epidemiology Intubation Intratracheal medicine Humans Hospital Mortality Prospective Studies Registries Cardiac Surgical Procedures Risk factor Quality Indicators Health Care Mechanical ventilation business.industry Age Factors Infant Newborn Odds ratio Length of Stay Intensive care unit Confidence interval Cardiac surgery Surgery Treatment Outcome 030228 respiratory system North America Cohort Airway Extubation Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 153:1519-1526 |
| ISSN: | 0022-5223 |
| Popis: | Objective In a multicenter cohort of neonates recovering from cardiac surgery, we sought to describe the epidemiology of extubation failure and its variability across centers, identify risk factors, and determine its impact on outcomes. Methods We analyzed prospectively collected clinical registry data on all neonates undergoing cardiac surgery in the Pediatric Cardiac Critical Care Consortium database from October 2013 to July 2015. Extubation failure was defined as reintubation less than 72 hours after the first planned extubation. Risk factors were identified using multivariable logistic regression with generalized estimating equations to account for within-center correlation. Results The cohort included 899 neonates from 14 Pediatric Cardiac Critical Care Consortium centers; 14% were premature, 20% had genetic abnormalities, 18% had major extracardiac anomalies, and 74% underwent surgery with cardiopulmonary bypass. Extubation failure occurred in 103 neonates (11%), within 24 hours in 61%. Unadjusted rates of extubation failure ranged from 5% to 22% across centers; this variability was unchanged after adjusting for procedural complexity and airway anomaly. After multivariable analysis, only airway anomaly was identified as an independent risk factor for extubation failure (odds ratio, 3.1; 95% confidence interval, 1.4-6.7; P = .01). Neonates who failed extubation had a greater median postoperative length of stay (33 vs 23 days, P P = .002). Conclusions This multicenter study showed that 11% of neonates recovering from cardiac surgery fail initial postoperative extubation. Only congenital airway anomaly was independently associated with extubation failure. We observed a 4-fold variation in extubation failure rates across hospitals, suggesting a role for collaborative quality improvement to optimize outcomes. |
| Databáze: | OpenAIRE |
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