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Kevin D Hill - One of the best experts on this subject based on the ideXlab platform.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
Jeffrey P Jacobs - One of the best experts on this subject based on the ideXlab platform.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
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clinical epidemiology of Extubation failure in the pediatric cardiac icu a report from the pediatric cardiac critical care consortium
Pediatric Critical Care Medicine, 2015Co-Authors: Michael Gaies, Sarah Tabbutt, Steven M Schwartz, Geoffrey L Bird, Jeffrey A Alten, Lara S Shekerdemian, Darren Klugman, Ravi R Thiagarajan, William J Gaynor, Jeffrey P JacobsAbstract:OBJECTIVE To describe the clinical epidemiology of Extubation failure in a multicenter cohort of patients treated in pediatric cardiac ICUs. DESIGN Retrospective cohort study using prospectively collected clinical registry data. SETTING Pediatric Cardiac Critical Care Consortium registry. PATIENTS All patients admitted to the CICU at Pediatric Cardiac Critical Care Consortium hospitals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Analysis of all mechanical ventilation episodes in the registry from October 1, 2013, to July 31, 2014. The primary outcome of Extubation failure was reintubation less than 48 hours after planned Extubation. Repeated-measures analysis using generalized estimating equations to account for within patient and center correlation was performed to identify risk factors for Extubation failure. Adjusted Extubation failure rates for each hospital were calculated using logistic regression controlling for patient factors. Of 1,734 mechanical ventilation episodes (1,478 patients at eight hospitals) ending in a planned Extubation, there were 100 Extubation failures (5.8%). In multivariable analysis, only longer duration of mechanical ventilation was significantly associated with Extubation failure (p = 0.01); the failure rate was 4% when ventilated less than 24 hours, 9% after 24 hours, and 13% after 7 days. For 503 patients intubated and extubated in the cardiac operating room, 15 patients (3%) failed Extubation within 48 hours (12 within 24 hr). Case-mix-adjusted Extubation failure rates ranged from 1.1% to 9.8% across hospitals. Patients failing Extubation had greater median cardiac ICU length of stay (15 vs 3 d; p < 0.001) and in-hospital mortality (7.9 vs 1.2%; p < 0.001). CONCLUSIONS Though Extubation failure is uncommon overall, there may be opportunities to improve Extubation readiness assessment in patients ventilated more than 24 hours. These data suggest that Extubation in the operating room after cardiac surgery can be done with a low failure rate. We observed variation in Extubation failure rates across hospitals, and future investigation must elucidate the optimal strategies of high-performing centers to reduce ventilation time while limiting Extubation failures.
William T Mahle - One of the best experts on this subject based on the ideXlab platform.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
Marshall L Jacobs - One of the best experts on this subject based on the ideXlab platform.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
Sara K Pasquali - One of the best experts on this subject based on the ideXlab platform.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
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early Extubation after repair of tetralogy of fallot and the fontan procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Sara K Pasquali, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early Extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early Extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan procedure. Centers were stratified into tertiles by frequency of early Extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early Extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan procedure. Early Extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early Extubation rate than for the lowest tertile centers, which have low early Extubation rate ( p = 0.04). No association was found between center early Extubation rate and PLOS for Fontan procedures ( p = 0.08). Conclusions Early Extubation is common after repair of TOF and the Fontan procedure. A high institutional rate of early Extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early Extubation might have on other meaningful measures such as resource use.
