Design and initial results of a programme for routine standardised longitudinal follow-up after congenital heart surgery.

2016

1590-1596

2016 Dec

1467-1107

<p><strong>BACKGROUND: </strong>With improvements in early survival following congenital heart surgery, it has become increasingly important to understand longer-term outcomes; however, routine collection of these data is challenging and remains very limited. We describe the development and initial results of a collaborative programme incorporating standardised longitudinal follow-up into usual care at the Children's Hospital of Philadelphia (CHOP) and University of Michigan (UM).</p>

<p><strong>METHODS: </strong>We included children undergoing benchmark operations of the Society of Thoracic Surgeons. Considerations regarding personnel, patient/parent engagement, funding, regulatory issues, and annual data collection are described, and initial follow-up rates are reported.</p>

<p><strong>RESULTS: </strong>The present analysis included 1737 eligible patients undergoing surgery at CHOP from January 2007 to December 2014 and 887 UM patients from January 2010 to December 2014. Overall, follow-up data, of any type, were obtained from 90.8% of patients at CHOP (median follow-up 4.3 years, 92.2% survival) and 98.3% at UM (median follow-up 2.8 years, 92.7% survival), with similar rates across operations and institutions. Most patients lost to follow-up at CHOP had undergone surgery before 2010. Standardised questionnaires assessing burden of disease/quality of life were completed by 80.2% (CHOP) and 78.4% (UM) via phone follow-up. In subsequent pilot testing of an automated e-mail system, 53.4% of eligible patients completed the follow-up questionnaire through this system.</p>

<p><strong>CONCLUSIONS: </strong>Standardised follow-up data can be obtained on the majority of children undergoing benchmark operations. Ongoing efforts to support automated electronic systems and integration with registry data may reduce resource needs, facilitate expansion across centres, and support multi-centre efforts to understand and improve long-term outcomes in this population.</p>

10.1017/S1047951116001669

Cardiol Young

28148316

A Single-Center Analysis of Methylprednisolone Use during Pediatric Cardiopulmonary Bypass.

2015

155-9

2015 Sep

0022-1058

<p>Cardiac surgery with the use of cardiopulmonary bypass (CPB) is known to induce an inflammatory response in patients. This response may be even more pronounced in pediatric patients given their small body size compared to adults. Several interventions have been instituted in an effort to attenuate this response, including the use of corticosteroids in the pump prime. However, the clinical effectiveness and potential harmful effects of steroid use have been the source of recent debate. Therefore, our institution made the decision to evaluate the use of methylprednisolone in our CPB prime. This evaluation was performed as a formal quality improvement project at The Children's Hospital of Philadelphia. Methylprednisolone was eliminated from the CPB prime for 6 months. At the end of this time period, The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate clinical outcomes of patients (n = 222). These outcomes were then compared to patients operated on during the 6 months prior to elimination of methylprednisolone (n = 303). No significant clinical benefit was identified in the group of patients who received methylprednisolone. When compared to the group who did not receive methylprednisolone, significantly more patients in the steroids group had a postoperative wound infection (p = .037) or respiratory failure requiring tracheostomy ( p = .035). No other differences in clinical outcomes were identified between the two groups. No significant differences in clinical outcomes were identified between neonates who received methylprednisolone (n = 55) and neonates who did not receive steroids (n = 58). Due to the lack of clinical benefit seen with its use, as well as its potential contribution to the incidence of wound infection, methylprednisolone continues to be excluded from the CPB prime at our institution. Methylprednisolone is still given intraoperatively at the request of the attending anesthesiologist and on bypass during orthotopic transplant procedures according to institutional protocol.</p>

J Extra Corpor Technol

26543249

Improving Cardiac Surgical Site Infection Reporting and Prevention By Using Registry Data for Case Ascertainment.

2016

190-9

2016 Jan

1552-6259

<p><strong>BACKGROUND: </strong>The use of administrative data for surgical site infection (SSI) surveillance leads to inaccurate reporting of SSI rates [1]. A quality improvement (QI) initiative was conducted linking clinical registry and administrative databases to improve reporting and reduce the incidence of SSI [2].</p>

<p><strong>METHODS: </strong>At our institution, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and infection surveillance database (ISD) were linked to the enterprise data warehouse containing electronic health record (EHR) billing data. A data visualization tool was created to (1) use the STS-CHSD for case ascertainment, (2) resolve discrepancies between the databases, and (3) assess impact of QI initiatives, including wound alert reports, bedside reviews, prevention bundles, and billing coder education.</p>

<p><strong>RESULTS: </strong>Over the 24-month study period, 1,715 surgical cases were ascertained according to the STS-CHSD clinical criteria, with 23 SSIs identified through the STS-CHSD, 20 SSIs identified through the ISD, and 32&nbsp;SSIs identified through the billing database. The rolling 12-month STS-CHSD SSI rate decreased from 2.73% (21 of 769 as of January 2013) to 1.11% (9 of 813 as of December 2014). Thirty reporting discrepancies were reviewed to ensure accuracy. Workflow changes facilitated communication and improved adjudication of suspected SSIs. Billing coder education increased coding accuracy and narrowed variation between the 3 SSI sources. The data visualization tool demonstrated temporal relationships between QI initiatives and SSI rate reductions.</p>

<p><strong>CONCLUSIONS: </strong>Linkage of registry and infection control surveillance data with the EHR improves SSI surveillance. The visualization tool and workflow changes facilitated communication, SSI adjudication, and assessment of the QI initiatives. Implementation of these initiatives was associated with decreased SSI rates.</p>

10.1016/j.athoracsur.2015.07.042

Ann. Thorac. Surg.

26410159