Castellanos Daniel Alexander, Herrington Cynthia, Adler Stacey, Haas Karen, Ram Kumar S, Kung Grace C
Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #68, Los Angeles, CA, 90027, USA.
Division of Cardiothoracic Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #66, Los Angeles, CA, 90027, USA.
Pediatr Cardiol. 2016 Dec;37(8):1575-1580. doi: 10.1007/s00246-016-1472-x. Epub 2016 Aug 23.
A clinician-driven home monitoring program can improve interstage outcomes in single-ventricle patients. Sociodemographic factors have been independently associated with mortality in interstage patients. We hypothesized that even in a population with high-risk sociodemographic characteristics, a home monitoring program is effective in reducing interstage mortality. We defined interstage period as the time period between discharge following Norwood palliation and second-stage surgery. We reviewed the charts of patients for the three-year period before (group 1) and after (group 2) implementation of the home monitoring program. Clinical variables around Norwood palliation, during the interstage period, and at the time of second-stage surgery were analyzed. There were 74 patients in group 1 and 52 in group 2. 59 % patients were Hispanic, and 84 % lived in neighborhoods where over 5 % families lived below poverty line. There was no significant difference in pre-Norwood variables, Norwood discharge variables, age at second surgery, or outcomes at second surgery. There were more Sano shunts performed at the Norwood procedure as the source of pulmonary blood flow in group 2 (p value <0.05). There were more unplanned hospital admissions and percutaneous re-interventions in group 2. Patients in group 2 whose admission criteria included desaturation had a 45 % likelihood of having an unplanned re-intervention. Group 2 noted an 80 % relative reduction in interstage mortality (p < 0.01). In a multiple regression analysis, after accounting for ethnicity, socio-economic status, and source of pulmonary blood flow, enrollment in a home monitoring program independently predicted improved interstage survival (p < 0.01). A clinician-driven home monitoring program reduces interstage mortality even when the majority of patients has high-risk sociodemographic characteristics.
临床医生主导的家庭监测项目可改善单心室患者的过渡期结局。社会人口统计学因素与过渡期患者的死亡率独立相关。我们假设，即使在具有高风险社会人口统计学特征的人群中，家庭监测项目在降低过渡期死亡率方面也是有效的。我们将过渡期定义为诺伍德姑息手术后出院至二期手术之间的时间段。我们回顾了家庭监测项目实施前三年（第1组）和实施后三年（第2组）患者的病历。分析了诺伍德姑息手术前后、过渡期以及二期手术时的临床变量。第1组有74例患者，第2组有52例患者。59%的患者为西班牙裔，84%的患者居住在超过5%家庭生活在贫困线以下的社区。诺伍德手术前变量、诺伍德出院变量、二期手术年龄或二期手术结局方面无显著差异。在第2组中，作为肺血流来源，诺伍德手术中进行的桑诺分流更多（p值<0.05）。第2组计划外住院和经皮再次干预更多。入院标准包括血氧饱和度降低的第2组患者进行计划外再次干预的可能性为45%。第2组过渡期死亡率相对降低了80%（p<0.01）。在多元回归分析中，在考虑种族、社会经济地位和肺血流来源后，参与家庭监测项目可独立预测过渡期生存率提高（p<0.01）。即使大多数患者具有高风险社会人口统计学特征，临床医生主导的家庭监测项目也能降低过渡期死亡率。
