• Early Extubation in Infancy and Early Childhood Following Heart Surgery: outcome analysis and predictors of failure

      Esquivel, Raquel; Geister, Emma; Crethers, Danielle; Weatherholt, Danalynn; Sanchez, Maria Gabriela; Munoz, Gustavo; Polimenakos, Anastasios C.; Department of Cellular Biology and Anatomy; Department of Surgery; Polimenakos, Anastasios C.; et al. (1/31/2020)
      Fast-track (FT) strategies and early extubation (EE), when feasible, can have beneficial effect on clinical outcomes. Despite positive findings in adult cardiac surgery studies, EE procedures have not been rigorously evaluated in the pediatric cardiac populations. We sought to determine feasibility and clinical outcomes of EE in infancy and early childhood following congenital heart surgery (CHS), as well as identify predictors of failure and highlight cost implications related to FT. A retrospective chart review of children ?6 years old who underwent CHS at the Children�s Hospital of Georgia from January-December 2017 was performed. EE was defined as successful removal of the endotracheal tube in the operating room or upon arrival in intensive care unit (ICU). Multivariate analysis was used to compare peri-operative data, identify the predictors of EE failure, and assess total hospital cost. Of the 64 patients reviewed, mean hospital length of stay (LOS) was 6.97+/-4.1 days in EE compared to 21.78+/-13.45 days in non-EE (p�< 0.0001). There was a near 3-fold cost increase failing EE/fast track which impacted total hospital cost for EE compared to non-EE patients (p�<0.0001, mean: $51419.913 sd= 23,196.203). Deployment of FT strategy with EE is safe and feasible following CHS during infancy and early childhood. Proper customization and implementation, through patient modifiable variables, can have powerful impact on cost-containment.
    • Fast-Track Extubation in Infancy and Early Childhood Following Heart Surgery: outcome analysis and predictors of failure

      Geister, Emma; Esquivel, Raquel; Crethers, Danielle; Weatherholt, Danalynn; Sanchez, Maria Gabriela; Munoz, Gustavo; Polimenakos, Anastasios C.; Department of Cellular Biology and Anatomy; Department of Surgery; Polimenakos, Anastasios C.; et al. (1/30/2020)
      Early extubation (EE) has become a critical determinant in perioperative management following congenital heart surgery (CHS) during early childhood. Fast track (FT) strategies and EE, when feasible, can have beneficial effect on clinical outcomes. We sought to determine the impact of EE on clinical outcomes, total hospital costs, identify predictors of failure and suggested criteria for new patients. A retrospective chart review of children ?6 years old (n = 64) who underwent CHS between January-December 2017 was performed. EE was defined as successful removal of the endotracheal tube in the operating room or upon arrival in intensive care unit (ICU). Groups were identified as (A):EE/Fast track and (B):no EE. Determinants for EE failure were assessed, and cost analysis pursued.�We found 39 patients were EE compared to 25 that were not. Children who were EE (mean=6.795 days, sd = 4.250) spend significantly less (p�< 0.0001) overall time in the ICU compared to non-EE patients (mean= 19.960 days, sd= 13.081). We also found that the total hospital stay for patients who were EE (mean= 6.976 days, sd= 4.090) was significantly reduced compared to those who were not (mean=21.783 days, sd=13.450) (p�<0.0001). Furthermore, we found that children who were EE had a significant reduction (p�<0.0001, sd= 23,196.203) in total hospital cost than patients who were not EE. Based on our analysis, we concluded that EE is feasible following CHS during early childhood but requires team approach and thoughtful use of FT protocols.