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VARIATION IN PERIOPERATIVE MANAGEMENT OF NORWOOD SURGERY IN THE PEDIATRIC HEART NETWORK'S SINGLE VENTRICLE RECONSTRUCTION TRIAL
E428 JACC April 5, 2011 Volume 57, Issue 14
CONGENITAL CARDIOLOGY SOLUTIONS (ADULT CONGENITAL AND PEDIATRIC CARDIOLOGY) VARIATION IN PERIOPERATIVE MANAGEMENT OF NORWOOD SURGERY IN THE PEDIATRIC HEART NETWORK’S SINGLE VENTRICLE RECONSTRUCTION TRIAL ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Congenital Heart Surgery Abstract Category: 42. Congenital Heart Surgery Session-Poster Board Number: 1064-427 Authors: Richard G. Ohye, Gail D. Pearson, Minmin Lu, Jonathan Kaltman, Christopher Caldarone, Christopher Derby, Carolyn Dunbar-Masterson, J. William Gaynor, Jeffrey P. Jacobs, A. K. Kaza, Sara K. Pasquali, John F. Rhodes, Mark Scheurer, Eric Silver, Lynn A. Sleeper, Sarah Tabbutt, James S. Tweddell, Karen Uzark, Winfield Wells, Jane Newburger, for the Pediatric Heart Network Investigators, Bethesda, MD Background: In the Single Ventricle Reconstruction (SVR) Trial, infants undergoing the Norwood procedure were randomized to right-ventricle-topulmonary-artery shunt or modified Blalock-Taussig shunt. Apart from trial treatment strategies, subjects received local standard care. We present significant practice variations during Norwood hospitalization across at the 15 participating clinical sites. Methods: We analyzed trial variables that primarily reflect management preferences rather than patient characteristics or outcomes. Differences in practice variables were compared across sites using the chi-square test and ANOVA, for categorical and continuous measures. Results: Of 555 patients enrolled in the SVR trial, 549 underwent Norwood; 461 survived to discharge. Centers varied in the mean age at Norwood (3.3 - 10.8 days; p < .001). Rates of classic arch reconstruction varied from 41-100% and direct pulmonary artery to arch anastomosis from 0-59% (p<.001). Prior to Norwood, rates varied for intubation (29-91%; p < .001), and use of inhaled gases (CO2 0-40%, p < .001; N2 0-67%, <.001) Rates also varied for catheterization (0-18%; p < .001). Profound differences in perioperative management among centers were evident in key perioperative domains (Table). Conclusions: Clinical centers vary radically in their management practices during Norwood hospitalization. Further analyses are planned to adjust for case mix, and to define the relationship of these practices to patient outcomes. Perioperative Practice Variations Variable Mean lowest temp (°C) Mean hematocrit (%) Alpha blockade, % Aprotinin, % Steroids, % Ultrafiltration, % Open Sternum, % Discharge meds, mean # Gastrostomy tube at Norwood discharge
Range, 15 Sites 15.2 - 20.7 22.9 - 40.0 0 - 100 43 - 100 33 - 100 2 - 100 36 - 100 3.6 - 7.3 0 - 72
p-value < .001 < .001 < .001 < .001 < .001 < .001 < .001 < .001 < .001
CONGENITAL CARDIOLOGY SOLUTIONS (ADULT CONGENITAL AND PEDIATRIC CARDIOLOGY) VARIATION IN PERIOPERATIVE MANAGEMENT OF NORWOOD SURGERY IN THE PEDIATRIC HEART NETWORK’S SINGLE VENTRICLE RECONSTRUCTION TRIAL ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Congenital Heart Surgery Abstract Category: 42. Congenital Heart Surgery Session-Poster Board Number: 1064-427 Authors: Richard G. Ohye, Gail D. Pearson, Minmin Lu, Jonathan Kaltman, Christopher Caldarone, Christopher Derby, Carolyn Dunbar-Masterson, J. William Gaynor, Jeffrey P. Jacobs, A. K. Kaza, Sara K. Pasquali, John F. Rhodes, Mark Scheurer, Eric Silver, Lynn A. Sleeper, Sarah Tabbutt, James S. Tweddell, Karen Uzark, Winfield Wells, Jane Newburger, for the Pediatric Heart Network Investigators, Bethesda, MD Background: In the Single Ventricle Reconstruction (SVR) Trial, infants undergoing the Norwood procedure were randomized to right-ventricle-topulmonary-artery shunt or modified Blalock-Taussig shunt. Apart from trial treatment strategies, subjects received local standard care. We present significant practice variations during Norwood hospitalization across at the 15 participating clinical sites. Methods: We analyzed trial variables that primarily reflect management preferences rather than patient characteristics or outcomes. Differences in practice variables were compared across sites using the chi-square test and ANOVA, for categorical and continuous measures. Results: Of 555 patients enrolled in the SVR trial, 549 underwent Norwood; 461 survived to discharge. Centers varied in the mean age at Norwood (3.3 - 10.8 days; p < .001). Rates of classic arch reconstruction varied from 41-100% and direct pulmonary artery to arch anastomosis from 0-59% (p<.001). Prior to Norwood, rates varied for intubation (29-91%; p < .001), and use of inhaled gases (CO2 0-40%, p < .001; N2 0-67%, <.001) Rates also varied for catheterization (0-18%; p < .001). Profound differences in perioperative management among centers were evident in key perioperative domains (Table). Conclusions: Clinical centers vary radically in their management practices during Norwood hospitalization. Further analyses are planned to adjust for case mix, and to define the relationship of these practices to patient outcomes. Perioperative Practice Variations Variable Mean lowest temp (°C) Mean hematocrit (%) Alpha blockade, % Aprotinin, % Steroids, % Ultrafiltration, % Open Sternum, % Discharge meds, mean # Gastrostomy tube at Norwood discharge
Range, 15 Sites 15.2 - 20.7 22.9 - 40.0 0 - 100 43 - 100 33 - 100 2 - 100 36 - 100 3.6 - 7.3 0 - 72
p-value < .001 < .001 < .001 < .001 < .001 < .001 < .001 < .001 < .001